[HTML][HTML] Chorioamnionitis as a risk factor for necrotizing enterocolitis: a systematic review and meta-analysis

JV Been, S Lievense, LJI Zimmermann… - The Journal of …, 2013 - Elsevier
JV Been, S Lievense, LJI Zimmermann, BW Kramer, TGAM Wolfs
The Journal of pediatrics, 2013Elsevier
OBJECTIVE: To accumulate available evidence regarding the association between
antenatal inflammation and necrotizing enterocolitis (NEC). STUDY DESIGN: A systematic
literature search was performed using Medline, Embase, Cochrane Library, ISI Web of
Knowledge, and reference hand searches. Human studies published in English that
reported associations between chorioamnionitis or other indicators of antenatal
inflammation and NEC were eligible. Relevant associations were extracted and reported …
OBJECTIVE
To accumulate available evidence regarding the association between antenatal inflammation and necrotizing enterocolitis (NEC).
STUDY DESIGN
A systematic literature search was performed using Medline, Embase, Cochrane Library, ISI Web of Knowledge, and reference hand searches. Human studies published in English that reported associations between chorioamnionitis or other indicators of antenatal inflammation and NEC were eligible. Relevant associations were extracted and reported. Studies reporting associations between histological chorioamnionitis (HC) and NEC, HC with fetal involvement and NEC, and clinical chorioamnionitis and NEC were pooled in separate meta-analyses.
RESULTS
A total of 33 relevant studies were identified. Clinical chorioamnionitis was significantly associated with NEC (12 studies; n = 22 601; OR, 1.24; 95% CI, 1.01-1.52; P = .04; I2 = 12%), but the association between HC and NEC was not statistically significant (13 studies; n = 5889; OR, 1.39; 95% CI, 0.95-2.04; P = .09; I2 = 49%). However, HC with fetal involvement was highly associated with NEC (3 studies; n = 1640; OR, 3.29; 95% CI, 1.87-5.78; P ≤ .0001; I2 = 10%). Selection based on study quality did not affect the results. No indications of publication bias were apparent. Multivariate analyses in single studies generally attenuated the reported associations. Several associations between other markers of antenatal inflammation and NEC are reported.
CONCLUSION
Currently available evidence supports a role for antenatal inflammation in NEC pathophysiology. This finding emphasizes the need to further study the underlying mechanisms and evaluate potential interventions to improve postnatal intestinal outcomes.
Elsevier