Association of Chorioamnionitis With Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review, Meta-analysis, and Metaregression

Eduardo Villamor-Martinez; Maria Alvarez-Fuente; Amro M. T. Ghazi; Pieter Degraeuwe; Luc J. I. Zimmermann; Boris W. Kramer; Eduardo Villamor-Martinez

doi:10.1001/jamanetworkopen.2019.14611

Association of Chorioamnionitis With Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review, Meta-analysis, and Metaregression

Eduardo Villamor-Martinez^*, Maria Alvarez-Fuente, Amro M. T. Ghazi, Pieter Degraeuwe, Luc J. I. Zimmermann, Boris W. Kramer, Eduardo Villamor-Martinez^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

49 Citations (Web of Science)

Abstract

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.

Original language	English
Article number	1914611
Number of pages	21
Journal	Jama network open
Volume	2
Issue number	11
DOIs	https://doi.org/10.1001/jamanetworkopen.2019.14611
Publication status	Published - 6 Nov 2019

Keywords

BIRTH-WEIGHT INFANTS
CHRONIC LUNG-DISEASE
FETAL INFLAMMATORY RESPONSE
PERINATAL RISK-FACTORS
UREAPLASMA-UREALYTICUM COLONIZATION
RESPIRATORY-DISTRESS-SYNDROME
EARLY ADRENAL INSUFFICIENCY
POOR NEONATAL GROWTH
PREMATURE-INFANTS
HISTOLOGICAL CHORIOAMNIONITIS

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Cite this

Villamor-Martinez, E., Alvarez-Fuente, M., Ghazi, A. M. T., Degraeuwe, P., Zimmermann, L. J. I., Kramer, B. W., & Villamor-Martinez, E. (2019). Association of Chorioamnionitis With Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review, Meta-analysis, and Metaregression. Jama network open, 2(11), [1914611]. https://doi.org/10.1001/jamanetworkopen.2019.14611

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title = "Association of Chorioamnionitis With Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review, Meta-analysis, and Metaregression",

abstract = "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; PCONCLUSIONS 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.",

keywords = "BIRTH-WEIGHT INFANTS, CHRONIC LUNG-DISEASE, FETAL INFLAMMATORY RESPONSE, PERINATAL RISK-FACTORS, UREAPLASMA-UREALYTICUM COLONIZATION, RESPIRATORY-DISTRESS-SYNDROME, EARLY ADRENAL INSUFFICIENCY, POOR NEONATAL GROWTH, PREMATURE-INFANTS, HISTOLOGICAL CHORIOAMNIONITIS",

author = "Eduardo Villamor-Martinez and Maria Alvarez-Fuente and Ghazi, {Amro M. T.} and Pieter Degraeuwe and Zimmermann, {Luc J. I.} and Kramer, {Boris W.} and Eduardo Villamor-Martinez",

year = "2019",

month = nov,

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doi = "10.1001/jamanetworkopen.2019.14611",

language = "English",

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issn = "2574-3805",

publisher = "American Medical Association",

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TY - JOUR

T1 - Association of Chorioamnionitis With Bronchopulmonary Dysplasia Among Preterm Infants

T2 - A Systematic Review, Meta-analysis, and Metaregression

AU - Villamor-Martinez, Eduardo

AU - Alvarez-Fuente, Maria

AU - Ghazi, Amro M. T.

AU - Degraeuwe, Pieter

AU - Zimmermann, Luc J. I.

AU - Kramer, Boris W.

AU - Villamor-Martinez, Eduardo

PY - 2019/11/6

Y1 - 2019/11/6

N2 - 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; PCONCLUSIONS 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.

AB - 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; PCONCLUSIONS 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.

KW - BIRTH-WEIGHT INFANTS

KW - CHRONIC LUNG-DISEASE

KW - FETAL INFLAMMATORY RESPONSE

KW - PERINATAL RISK-FACTORS

KW - UREAPLASMA-UREALYTICUM COLONIZATION

KW - RESPIRATORY-DISTRESS-SYNDROME

KW - EARLY ADRENAL INSUFFICIENCY

KW - POOR NEONATAL GROWTH

KW - PREMATURE-INFANTS

KW - HISTOLOGICAL CHORIOAMNIONITIS

U2 - 10.1001/jamanetworkopen.2019.14611

DO - 10.1001/jamanetworkopen.2019.14611

M3 - Review article

C2 - 31693123

VL - 2

JO - Jama network open

JF - Jama network open

SN - 2574-3805

IS - 11

M1 - 1914611

ER -