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Open Access
CC BY 4.0 · Am J Perinatol 2024; 41(S 01): e3264-e3273
DOI: 10.1055/a-2215-0662
Original Article

Histological Chorioamnionitis and Funisitis as New Risk Factors for Retinopathy of Prematurity: A Meta-analysis

Salma El Emrani 
1   Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
2   Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
,
Esther J.S. Jansen
3   Division of Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
,
Jelle J. Goeman
4   Division of Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
,
Enrico Lopriore
2   Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
,
Jacqueline U.M. Termote
3   Division of Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
,
Nicoline E. Schalij-Delfos
1   Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
,
Lotte E. van der Meeren
5   Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
6   Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
› Author Affiliations
Funding ODAS Foundation (Grant number 2021-32327). ODAS foundation had no role in the design or conduct of the study.
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Abstract

Objective The role of placental inflammation in neonatal morbidities is underestimated due to lack of placental examination. This meta-analysis aims to assess the association between histological chorioamnionitis (HCA) with and without funisitis (FUN) and risk of retinopathy of prematurity (ROP).

Study Design Forty-five studies reporting (unadjusted) data on HCA without FUN and HCA with FUN in neonates with ROP were included. Primary outcomes were any stage ROP and severe ROP. Potential confounders explored were gestational age (GA) at birth, birthweight, maternal steroid use, necrotizing enterocolitis, sepsis (suspected/proven) and mechanical ventilation duration.

Results Neonates with HCA had increased risk for any stage ROP (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3–2.4) and severe ROP (OR 1.5; 95% CI 1.2–1.8) compared with neonates without HCA. The rates of any stage ROP (OR 1.8; 95% CI 1.4–2.2) and severe ROP (OR 1.4; 95% CI 1.1–1.6) were higher in neonates with FUN compared with neonates without FUN. Multivariate meta-regression analysis suggests that lower GA increases the effect size between FUN and severe ROP.

Conclusion This meta-analysis confirms that presence of HCA and FUN are risk factors for any stage ROP and severe ROP. Structured histological placental examination of HCA and FUN may be a tool to further refine the ROP risk profile.

Key Points

  • This systematic review confirms that HCA is a risk factor for ROP.

  • This meta-analysis reveals that FUN results in an even higher risk for developing ROP.

  • Placental examination of HCA/FUN may be a tool to further refine the ROP risk profile.

Keywords

retinopathy of prematurity - histological chorioamnionitis - funisitis - prematurity - meta-analysis

Supplementary Material



Publication History

Received: 06 April 2023

Accepted: 15 November 2023

Accepted Manuscript online:
21 November 2023

Article published online:
28 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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