Chorioamnionitis and Patent Ductus Arteriosus: A Systematic Review and Meta-Analysis

Abstract

BackgroundChorioamnionitis has recently been reported as a risk factor for various neonatal diseases, including cerebral palsy, bronchopulmonary dysplasia, and necrotizing enterocolitis, but its effect on patent ductus arteriosus (PDA) is unclear. We performed a systematic review and meta-analysis to evaluate the effect of chorioamnionitis on PDA.MethodsWe searched PubMed, EMBASE, Cochrane Library, and KoreaMed databases using the terms: “intrauterine infection” or “maternal infection” or “antenatal infection” or “chorioamnionitis” or “placenta inflammation” or “placenta pathology” or “neonatal outcome” or “neonatal morbidity” or “PDA or patent ductus arteriosus” or “ductus arteriosus,” and “prematurity” or “very low birth weight infant.” Studies were included if they were randomized controlled trials, case–control studies, or cohort studies that included information relating to chorioamnionitis and PDA.ResultsAmong 1,571 studies, a total of 23 studies (17,708 cases) were included in the meta-analysis to analyze the relationship between chorioamnionitis and PDA, except one study that only included PDA requiring surgical ligation. The association between chorioamnionitis and PDA was statistically significant (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.19, 1.72; P < 0.0001). In subgroup analysis, clinical chorioamnionitis was not associated with PDA (OR 1.28; 95% CI 1.00, 1.64, 1.790; P = 0.05), whereas histologic chorioamnionitis (OR 1.54; 95% CI 1.10, 2.15; P = 0.01) and chorioamnionitis diagnosed from both clinical and histologic findings (OR 1.75; 95% CI 1.07, 2.86; P = 0.03) showed significant associations with PDA. Chorioamnionitis did not increase the risk of PDA requiring surgical ligation (OR 1.23; 95% CI 0.69, 2.17; P = 0.48), and antenatal steroid use reduced the risk of PDA (OR 0.62; 95% CI 0.42, 0.90; P = 0.01) after chorioamnionitis.ConclusionsThe results from this meta-analysis support an association between maternal chorioamnionitis and PDA in offspring.

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

“…Prenatal corticosteroid prophylaxis decreases the risk for PDA [14,16,49,54,55], even if administered after chorioamnionitis [24]. In the present study, similar proportions of infants with and without PDA received prenatal corticosteroids, and even if more infants received a complete course, the difference between the two groups was not significant p>0.050.…”

“…They also found that antepartum haemorrhage occurred more often in premature infants with PDA. Many studies linked chorioamnionitis to PDA in preterm infants [3,15,[23][24][25]56]. In these cases, inflammation increases cyclo-oxygenase activity and prostaglandin E2 production causing PDA [56].…”

“…In these cases, inflammation increases cyclo-oxygenase activity and prostaglandin E2 production causing PDA [56]. Pregnancy-induced hypertension and eclampsia are associated with decreased incidence of PDA as these conditions are characterized by accelerated pulmonary [24]. The study performed by Hammoud et al was the only one found that reported an association between PDA and multiple pregnancies [14].…”

“…Multiple risk factors have been described in association with PDA such as lower GA and BW [14][15][16]21,22], chorioamnionitis and neonatal sepsis, [3,15,[22][23][24][25], maternal diabetes mellitus, [14,26] antepartum hemorrhage, multiple pregnancy, male gender [14], small for gestational age (SGA), [27] lower Apgar scores, need for resuscitation at birth, asphyxia [16], severe respiratory distress syndrome (RDS) [16,22,28,29], excessive fluid administration during the first days of life [30], Furosemide administration [31], decreased platelets number during the first day of life [22,32], oxygen administration [16], lower oxygen saturation targets [33,34], surfactant administration [16,28,35,36], increased duration of mechanical ventilation and respiratory support [22], metabolic acidosis [16], phototherapy [37], and high altitude [6].…”

“…In the short term, PDA is associated with decreased blood pressure [5,8], decreased renal function [5], cardiac congestive failure [18,37,38], pulmonary haemorrhage [8,39], apnea and ventilator-dependency [6,38], bronchopulmonary dysplasia (BPD) [5,14,20,21,25,34,41,42], necrotizing enterocolitis (NEC) [8,9,11,19,20,34,39,43,44], intraventricular hemorrhage (IVH) [5,19,20,39,42,45,46], periventricular leukomalacia (PVL) [5], retinopathy of prematurity (ROP), cerebral palsy [24], delayed growth [11], and increased mortality rate [6,34,45,[47][48][49][50].…”