IMPORTANCE Bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurity, remains one of the major and most common complications of very preterm birth. Insight into factors associated with the pathogenesis of BPD is key to improving its prevention and treatment.
OBJECTIVE To perform a systematic review, meta-analysis, and metaregression of clinical studies exploring the association between chorioamnionitis (CA) and BPD in preterm infants.
DATA SOURCES PubMed and Embase were searched without language restriction (last search, October 1, 2018). Key search terms included bronchopulmonary dysplasia, chorioamnionitis, and risk factors.
STUDY SELECTION Included studies were peer-reviewed studies examining preterm (
DATA EXTRACTION AND SYNTHESIS TheMeta-analysis of Observational Studies in Epidemiology (MOOSE) guideline was followed. Data were independently extracted by 2 researchers. A randomeffects model was used to calculate odds ratios (ORs) and 95% CIs. Heterogeneity in effect size across studies was studied using multivariate, random-effects metaregression analysis.
MAIN OUTCOMES AND MEASURES The primary outcome was BPD, defined as supplemental oxygen requirement on postnatal day 28 (BPD28) or at the postmenstrual age of 36 weeks (BPD36). Covariates considered as potential confounders included differences between CA-exposed and CA-unexposed infants in gestational age, rates of respiratory distress syndrome (RDS), exposure to antenatal corticosteroids, and rates of early- and late-onset sepsis.
RESULTS A total of 3170 potentially relevant studies were found, of which 158 met the inclusion criteria (244 096 preterm infants, 20 971 CA cases, and 24 335 BPD cases). Meta-analysis showed that CA exposure was significantly associated with BPD28 (65 studies; OR, 2.32; 95% CI, 1.88-2.86; P
CONCLUSIONS AND RELEVANCE The results of this study confirm that among preterm infants, exposure to CA is associated with a higher risk of developing BPD, but this association may be modulated by gestational age and risk of RDS.
|Number of pages||21|
|Journal||Jama network open|
|Publication status||Published - 6 Nov 2019|
- BIRTH-WEIGHT INFANTS
- CHRONIC LUNG-DISEASE
- FETAL INFLAMMATORY RESPONSE
- PERINATAL RISK-FACTORS
- UREAPLASMA-UREALYTICUM COLONIZATION
- EARLY ADRENAL INSUFFICIENCY
- POOR NEONATAL GROWTH
- HISTOLOGICAL CHORIOAMNIONITIS