Urinary I-FABP levels are not suitable as screening tool for NEC before clinical suspicion. However, urinary I-FABP and claudin-3 and fecal calprotectin are promising diagnostic markers for NEC. Furthermore, urinary I-FABP might also be used to predict disease severity.

Key PointsQuestionIs chorioamnionitis a risk factor for developing bronchopulmonary dysplasia in preterm infants?FindingsThis systematic review, meta-analysis, and metaregression found that chorioamnionitis was associated with an increased risk of bronchopulmonary dysplasia in preterm infants but also found significant differences in baseline characteristics between infants with and infants without chorioamnionitis. A multivariate metaregression model combining the difference in gestational age and the odds of respiratory distress syndrome was associated with 64% of the variance in the association between chorioamnionitis and bronchopulmonary dysplasia.MeaningExposure to chorioamnionitis is associated with a higher risk of developing bronchopulmonary dysplasia in preterm infants, but this association may be modulated by gestational age and risk of respiratory distress syndrome.

collected hourly for five hours. Abdominal pain was quantified using visual analogue pain scores. Reference ranges were 23 to 300 U/l for serum lipase and 30 to 110 U/l for serum amylase. The 24 patients subsequently underwent TDS/TAS and the Nardi test was repeated 12 months postoperatively. The gastrointestinal quality of life index (GIQLI) 6 was measured preoperatively and 12 months postoperatively. The two studies were approved by the ethics committees of the University of Nottingham Medical School and Nottingham University Hospitals. Informed written consent was obtained.The median (range) age of the 14 male and six female volunteers was 21 (18 to 23) years. Serum lipase and amylase concentrations increased more than fourfold over baseline in 15 (75%) and 13 (65%) healthy subjects, respectively, after morphine-prostigmine provocation. The median (interquartile range) baseline and maximum post-provocation concentrations of serum lipase were 120 (74 to 138) and 2930 (344 to 7824) U/l, respectively; corresponding values for serum amylase were 61 (44 to 81) and 220 (91 to 545) U/l (p,0.001, Wilcoxon signed ranks test). Figure 1 shows the maximum increase in enzymes over baseline for each subject, none of whom experienced pain during the study.The median (range) age of the three male and 21 female patients was 42 (25 to 64) years. The post-provocation enzymatic increases were significantly greater preoperatively than post-

Background There is debate concerning the safety and efficacy of antenatal steroids in preterm labour with suspected intrauterine infection (chorioamnionitis).Objectives We performed a systematic literature review and metaanalysis aimed at evaluating the efficacy and safety of antenatal steroids in clinical and histological chorioamnionitis.Search strategy MEDLINE, EMBASE, BioMed Central and the Cochrane databases were searched using the terms 'chorioamnionitis OR intrauterine infection' and '*steroids OR *corticoids'.Selection criteria Studies that reported selected neonatal outcome measures in preterm infants with clinical or histological chorioamnionitis, according to antenatal steroid exposure, were eligible.Data collection and analysis Study selection, data extraction and data analysis were performed by two independent investigators. The meta-analysis techniques used included: Mantel-Haenszel analysis; an assessment of study heterogeneity using the Q statistic; and Egger's regression test and funnel plots, to assess publication bias.Main results Seven observational studies were included. In histological chorioamnionitis (five studies), antenatal steroids were associated with reduced mortality (OR = 0.45; 95% CI = 0.30-0.68; P = 0.0001), respiratory distress syndrome (OR = 0.53; 95% CI = 0.40-0.71; P < 0.0001), patent ductus arteriosus (OR = 0.56; 95% CI = 0.37-0.85; P = 0.007), intraventricular haemorrhage (IVH; OR = 0.35; 95% CI = 0.18-0.66; P = 0.001) and severe IVH (OR = 0.39; 95% CI = 0.19-0.82; P = 0.01). In clinical chorioamnionitis (four studies), antenatal steroids were associated with reduced severe IVH (OR = 0.29; 95% CI = 0.10-0.89; P = 0.03) and periventricular leucomalacia (OR = 0.35; 95% CI = 0.14-0.85; P = 0.02).Conclusions Antenatal steroids may be safe and reduce adverse neonatal outcome after preterm birth associated with chorioamnionitis. There is a need for randomised clinical trials to address this issue.

The contribution of chorioamnionitis (CA) to mortality and morbidity in preterm infants is difficult to assess because observational studies frequently present significant differences in baseline characteristics of the infants exposed or non-exposed to CA. In an attempt to perform a thorough assessment of the possible association between CA and patent ductus arteriosus (PDA) in preterm infants, we conducted a meta-analysis in which adjusted odds ratios (ORs) were pooled and we analyzed the effects of potential confounders, such as gestational age (GA) or birth weight (BW). We identified 45 relevant studies (27186 patients, 7742 CA cases). Random effects meta-analysis of crude ORs showed a significant positive association between CA and PDA (OR 1.352, 95% CI 1.172 to 1.560). Adjusted ORs were reported in 11 studies (19577 infants). Meta-analysis of these studies showed a significant negative association between CA and PDA (OR 0.802, 95% CI 0.751 to 0.959). Meta-regression showed that the differences in GA or BW between the CA-exposed and non-exposed groups were significantly correlated with the effect size of the association between PDA and CA. In conclusion, our study confirms that confounders need to be taken into account when assessing the association between CA and clinical outcomes in preterm infants.