Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis
September
Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta- Analysis
Editor: Olivier Baud 0
Hôpital Robert Debré 0
FRANCE 0
Hye Won Park 0
Yong-Sung Choi 0
Kyo Sun Kim 0
Soo-Nyung Kim 0
0 1 Department of Pediatrics, Konkuk University Medical Center , Seoul , Korea , 2 Konkuk University School of Medicine , Seoul , Korea , 3 Department of Pediatrics, Kyung Hee University School of Medicine , Seoul , Korea , 4 Department of Obstetrics and Gynecology, Konkuk University Medical Center , Seoul , Korea
Chorioamnionitis has recently been reported as a risk factor for various neonatal diseases, including cerebral palsy, bronchopulmonary dysplasia, and necrotizing enterocolitis, but its effect on patent ductus arteriosus (PDA) is unclear. We performed a systematic review and meta-analysis to evaluate the effect of chorioamnionitis on PDA.
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Competing Interests: The authors have declared
that no competing interests exist.
We searched PubMed, EMBASE, Cochrane Library, and KoreaMed databases using the
terms: “intrauterine infection” or “maternal infection” or “antenatal infection” or
“chorioamnionitis” or “placenta inflammation” or “placenta pathology” or “neonatal outcome” or “neonatal
morbidity” or “PDA or patent ductus arteriosus” or “ductus arteriosus,” and “prematurity” or
“very low birth weight infant.” Studies were included if they were randomized controlled
trials, case–control studies, or cohort studies that included information relating to
chorioamnionitis and PDA.
Among 1,571 studies, a total of 23 studies (17,708 cases) were included in the
meta-analysis to analyze the relationship between chorioamnionitis and PDA, except one study that
only included PDA requiring surgical ligation. The association between chorioamnionitis
and PDA was statistically significant (odds ratio [OR] 1.43; 95% confidence interval [CI]
1.19, 1.72; P < 0.0001). In subgroup analysis, clinical chorioamnionitis was not associated
with PDA (OR 1.28; 95% CI 1.00, 1.64, 1.790; P = 0.05), whereas histologic
chorioamnionitis (OR 1.54; 95% CI 1.10, 2.15; P = 0.01) and chorioamnionitis diagnosed from both clinical
and histologic findings (OR 1.75; 95% CI 1.07, 2.86; P = 0.03) showed significant
associations with PDA. Chorioamnionitis did not increase the risk of PDA requiring surgical ligation
(OR 1.23; 95% CI 0.69, 2.17; P = 0.48), and antenatal steroid use reduced the risk of PDA
(OR 0.62; 95% CI 0.42, 0.90; P = 0.01) after chorioamnionitis.
The results from this meta-analysis support an association between maternal
chorioamnionitis and PDA in offspring.
Chorioamnionitis is a risk factor for preterm birth, but the relationship between
chorioamnionitis and neonatal morbidity or mortality remains controversial. However, several
metaanalyses recently reported chorioamnionitis as a risk factor for various neonatal diseases, such
as cerebral palsy [1], retinopathy of prematurity [2], bronchopulmonary dysplasia [3], and
necrotizing enterocolitis [4]. Although the routine treatment of patent ductus arteriosus (PDA) is
not recommended, persistent shunting through symptomatic PDA could increase the risk of
neonatal mortality and morbidity, including chronic lung disease, intraventricular
hemorrhage, and necrotizing enterocolitis [5, 6]. In the case of PDA, it has been reported that
chorioamnionitis was a risk factor for unresponsiveness to medical therapy with cyclooxygenase
inhibitors [7, 8]. The effect of antenatal steroids after chorioamnionitis has been reported [9],
but the effect of chorioamnionitis itself on PDA occurrence is unclear. We performed a
systematic review and meta-analysis to evaluate the effect of maternal chorioamnionitis on PDA in
offspring.
Materials and Methods
Search Strategy and Study Selection
We performed this meta-analysis in accordance with the PRISMA guidelines developed for
systematic reviews and meta-analyses (S1 PRISMA Checklist). We searched PubMed,
EMBASE, Cochrane Library, and KoreaMed databases using the terms: “intrauterine infection”
or “maternal infection” or “antenatal infection” or “chorioamnionitis” or “placenta
inflammation” or “placenta pathology” or “neonatal outcome” or “neonatal morbidity” or “PDA” or
“patent ductus arteriosus” or “ductus arteriosus,” and “prematurity” or “very low birth weight
infant.” Manual searches were also performed on the reference lists of included studies and
other electronic databases. No restrictions were applied on language. The last search was
performed on September 19, 2014. The titles and abstracts of the articles were initially screened,
and the full-text articles were independently reviewed by two reviewers (HW Park and YS
Choi) using the selection criteria to determine inclusion in the meta-analysis.
Studies were included for meta-analysis if they met the following criteria: 1) study design:
randomized controlled trial, case-control study, or prospectively or retrospectively matched
cohort study; 2) patients: preterm infants who we (...truncated)