Lissone Neirude P A, Hundscheid Tamara M, Galán-Henríquez Gloria M, González-Luis Gema E, Bartoš František, Villamor Eduardo
Division of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Research Institute for Oncology and Reproduction (GROW), Maastricht University, 6202 AZ Maastricht, The Netherlands.
Department of Pediatrics, Hospital Universitario Materno-Infantil de Canarias, E-35016 Las Palmas de Gran Canaria, Spain.
Children (Basel). 2025 Aug 13;12(8):1065. doi: 10.3390/children12081065.
Pathophysiological pathways-or endotypes-leading to prematurity can be clustered into two groups: infection/inflammation and dysfunctional placentation. We aimed to perform a systematic review and meta-analysis of studies exploring the association between these endotypes and cystic periventricular leukomalacia (cPVL). PubMed and Embase were searched for observational studies examining preterm infants and reporting data on the association between endotype of prematurity and cPVL. Chorioamnionitis represented the infectious-inflammatory endotype, while dysfunctional placentation proxies were hypertensive disorders of pregnancy (HDPs) and small for gestational age (SGA)/intrauterine growth restriction (IUGR). Bayesian model-averaged (BMA) meta-analysis was used to calculate Bayes factors (BFs). The BF is the ratio of the probability of the data under the alternative hypothesis (H presence of association) over the probability of the data under the null hypothesis (H absence of association). Of 1141 potentially relevant studies; 67 (108,571 infants) were included. The BMA analysis showed strong evidence in favor of a positive association between chorioamnionitis and cPVL (OR 1.58; 95% CrI 1.12 to 2.20; BF = 20.5) and extreme evidence in favor of a negative association between HDPs and cPVL (OR 0.63; 95% CrI 0.54 to 0.75; BF = 2937). The evidence for the SGA/IUGR group was inconclusive (OR 0.87; 95% CrI 0.75 to 1.01; BF = 1.41). This Bayesian meta-analysis provides evidence indicative of an association between antenatal infection-inflammation and an increased risk of developing cPVL in preterm infants. Conversely, infants exposed to HDPs are less likely to develop cPVL.
感染/炎症和胎盘功能障碍。我们旨在对探索这些内型与脑室周围白质软化（cPVL）之间关联的研究进行系统综述和荟萃分析。在PubMed和Embase数据库中检索了观察性研究，这些研究对早产儿进行了检查，并报告了早产内型与cPVL之间关联的数据。绒毛膜羊膜炎代表感染性炎症内型，而胎盘功能障碍的替代指标是妊娠高血压疾病（HDPs）和小于胎龄儿（SGA）/宫内生长受限（IUGR）。采用贝叶斯模型平均（BMA）荟萃分析来计算贝叶斯因子（BFs）。贝叶斯因子是备择假设（存在关联的H）下数据的概率与零假设（不存在关联的H）下数据的概率之比。在1141项潜在相关研究中，纳入了67项（108571名婴儿）。BMA分析显示有强有力的证据支持绒毛膜羊膜炎与cPVL之间存在正相关（OR 1.58；95% CrI 1.12至2.20；BF = 20.5），并有极强的证据支持HDPs与cPVL之间存在负相关（OR 0.63；95% CrI 0.54至0.75；BF = 2937）。SGA/IUGR组的证据尚无定论（OR 0.87；95% CrI 0.75至1.01；BF = 1.41）。这项贝叶斯荟萃分析提供的证据表明，产前感染炎症与早产儿发生cPVL的风险增加之间存在关联。相反，暴露于HDPs的婴儿发生cPVL的可能性较小。
