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

Salma El Emrani; Esther J.S. Jansen; Jelle J. Goeman; Enrico Lopriore; Jacqueline U.M. Termote; Nicoline E. Schalij-Delfos; Lotte E. van der Meeren

doi:10.1055/a-2215-0662

American Journal of Perinatology, Table of Contents

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

Authors

Salma El Emrani

¹Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands

²Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
Esther J.S. Jansen

³Division of Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
Jelle J. Goeman

⁴Division of Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
Enrico Lopriore

²Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
Jacqueline U.M. Termote

³Division of Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
Nicoline E. Schalij-Delfos

¹Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
Lotte E. van der Meeren

⁵Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands

⁶Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands

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

Full Text

References

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