The histologic fetal inflammatory response and neonatal outcomes: systematic review and meta-analysis

被引:9
作者
Kovacs, Kinga [1 ,2 ]
Kovacs, Ozike Zsuzsanna [1 ,2 ]
Bajzat, Dorina [1 ,3 ]
Imrei, Marcell [1 ,3 ]
Nagy, Rita [1 ]
Nemeth, David [1 ]
Koi, Tamus [1 ]
Szabo, Miklos [2 ,4 ]
Fintha, Attila [5 ]
Hegyi, Peter [1 ,6 ,7 ]
Garami, Miklos [1 ,8 ]
Gasparics, Akos [2 ]
机构
[1] Semmelweis Univ, Ctr Translat Med, Budapest, Hungary
[2] Semmelweis Univ, Dept Obstet & Gynecol, Budapest, Hungary
[3] Heim Pal Natl Pediat Inst, Budapest, Hungary
[4] Semmelweis Univ, Dept Pediat 1, Div Neonatol, Budapest, Hungary
[5] Semmelweis Univ, Fac Med, Dept Pathol & Canc Res, Budapest, Hungary
[6] Univ Pecs, Inst Translat Med, Szentagotha Res Ctr, Med Sch, Pecs, Hungary
[7] Semmelweis Univ, Inst Pancreat Dis, Budapest, Hungary
[8] Semmelweis Univ, Dept Pediat, Budapest, Hungary
关键词
bronchopulmonary dysplasia; early-onset sepsis; fetal inflammatory response; fetal inflammatory response syndrome; funisitis; histological chorioamnionitis; intraventricular hemorrhage; intrauterine inflammation; meta-analysis; preterm; sepsis; systematic review; RESPIRATORY-DISTRESS-SYNDROME; LINEAR MIXED-MODEL; LOW-BIRTH-WEIGHT; PRETERM INFANTS; BRONCHOPULMONARY DYSPLASIA; AMNIOTIC-FLUID; CLINICAL CHORIOAMNIONITIS; PLACENTAL INFLAMMATION; RISK-FACTORS; NEURODEVELOPMENTAL IMPAIRMENT;
D O I
10.1016/j.ajog.2023.11.1223
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: This study aimed to investigate the prognostic role of concomitant histological fetal inflammatory response with chorioamnionitis on neonatal outcomes through a systematic review and meta-analysis of existing literature. DATA SOURCES: The primary search was conducted on October 17, 2021, and it was updated on May 26, 2023, across 4 separate databases (MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, and Scopus) without using any filters. STUDY ELIGIBILITY CRITERIA: Observational studies reporting obstetrical and neonatal outcomes of infant-mother dyads with histological chorioamnionitis and histological fetal inflammatory response vs infant-mother dyads with histological chorioamnionitis alone were eligible. Studies that enrolled only preterm neonates, studies on neonates born before 37 weeks of gestation, or studies on neonates with very low birthweight (birthweight <1500 g) were included. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42021283448). METHODS: The records were selected by title, abstract, and full text, and disagreements were resolved by consensus. Random-effect model-based pooled odds ratios with corresponding 95% confidence intervals were calculated for dichotomous outcomes. RESULTS: Overall, 50 studies were identified. A quantitative analysis of 14 outcomes was performed. Subgroup analysis using the mean gestational age of the studies was performed, and a cutoff of 28 weeks of gestation was implemented. Among neonates with lower gestational ages, early-onset sepsis (pooled odds ratio, 2.23; 95% confidence interval, 1.76-2.84) and bronchopulmonary dysplasia (pooled odds ratio, 1.30; 95% confidence interval, 1.02-1.66) were associated with histological fetal inflammatory response. Our analysis showed that preterm neonates with a concomitant histological fetal inflammatory response are more likely to develop intraventricular hemorrhage (pooled odds ratio, 1.54; 95% confidence interval, 1.18-2.02) and retinopathy of prematurity (pooled odds ratio, 1.37; 95% confidence interval, 1.03-1.82). The odds of clinical chorioamnionitis were almost 3-fold higher among infant-mother dyads with histological fetal inflammatory response than among infant-mother dyads with histological chorioamnionitis alone (pooled odds ratio, 2.99; 95% confidence interval, 1.96-4.55). CONCLUSION: This study investigated multiple neonatal outcomes and found association in the case of 4 major morbidities: early-onset sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity.
引用
收藏
页码:493 / 511.e3
页数:22
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