Histological chorioamnionitis and funisitis as new risk factors for retinopathy of prematurity: a meta-analysis

Salma El Emrani*, Esther Smit-Jansen, Jelle Goeman, Enrico Lopriore, Jacqueline Termote, Nicoline Schalij-Delfos, Lotte Van Der Meeren

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)E3264-E3273
JournalAmerican Journal of Perinatology
Volume41
DOIs
Publication statusPublished - May 2024

Keywords

  • Funisitis
  • Histological chorioamnionitis
  • Meta-analysis
  • Prematurity
  • Retinopathy of prematurity

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