Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis

PLOS ONE, Dec 2019

Background 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. Methods 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. Results 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. Conclusions The results from this meta-analysis support an association between maternal chorioamnionitis and PDA in offspring.

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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. - 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)


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Hye Won Park, Yong-Sung Choi, Kyo Sun Kim, Soo-Nyung Kim. Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis, PLOS ONE, 2015, 9, DOI: 10.1371/journal.pone.0138114