Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary; Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
Am J Obstet Gynecol. 2024 May;230(5):493-511.e3. doi: 10.1016/j.ajog.2023.11.1223. Epub 2023 Nov 13.
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.
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.
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).
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.
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).
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.
本研究通过对现有文献进行系统回顾和荟萃分析，旨在探讨伴有组织学绒毛膜羊膜炎的胎儿炎症反应对新生儿结局的预后作用。
首次检索于 2021 年 10 月 17 日，于 2023 年 5 月 26 日进行了更新，检索了 4 个独立数据库（MEDLINE、Cochrane 对照试验中心注册库、Embase 和 Scopus），未使用任何筛选条件。
纳入报道了伴有组织学绒毛膜羊膜炎和组织学胎儿炎症反应的母婴对子与仅伴有组织学绒毛膜羊膜炎的母婴对子的产科和新生儿结局的观察性研究。纳入仅纳入早产儿、妊娠 37 周前出生的新生儿或极低出生体重儿（出生体重<1500g）的研究。本研究方案已在国际前瞻性系统评价注册中心（注册号：CRD42021283448）进行了注册。
通过标题、摘要和全文筛选记录，通过共识解决分歧。使用基于随机效应模型的汇总比值比及其相应的 95%置信区间来计算二分类结局。
共确定了 50 项研究。对 14 项结局进行了定量分析。使用研究的平均胎龄进行了亚组分析，并采用 28 周的胎龄作为截断值。在胎龄较低的新生儿中，早发型败血症（汇总比值比，2.23；95%置信区间，1.76-2.84）和支气管肺发育不良（汇总比值比，1.30；95%置信区间，1.02-1.66）与组织学胎儿炎症反应相关。我们的分析表明，伴有组织学胎儿炎症反应的早产儿更易发生脑室出血（汇总比值比，1.54；95%置信区间，1.18-2.02）和早产儿视网膜病变（汇总比值比，1.37；95%置信区间，1.03-1.82）。与仅伴有组织学绒毛膜羊膜炎的母婴对子相比，伴有组织学胎儿炎症反应的母婴对子发生临床绒毛膜羊膜炎的几率几乎高出 3 倍（汇总比值比，2.99；95%置信区间，1.96-4.55）。
本研究调查了多种新生儿结局，并发现 4 种主要疾病存在关联：早发型败血症、支气管肺发育不良、脑室出血和早产儿视网膜病变。
