PhD Scientific Days 2022

Clinical Medicine III.

Twists and Turns Around Chorioamnionitis: The Histopathologic Fetal Inflammatory Response and Neonatal Outcomes

Text of the abstract

Introduction: One of the leading causes of preterm deliveries is intrauterine inflammation. There is a large amount of evidence confirming the association between chorioamnionitis (CA) and the adverse outcomes of preterm neonates. Histopathologic fetal inflammatory response (HFIR) is considered as a progression of chorioamnionitis and is characterized by the inflammation of the chorionic and umbilical vessels and the Wharton jelly.
Aims: Our objective was to investigate if the presence of HFIR was accompanied by further deterioration of the prognosis.
Methods: For this systematic review and meta-analysis, a literature search was conducted on October 17th, 2021, across four separate databases (MEDLINE, CENTRAL, Embase and Scopus). The records were selected by title, abstract, and full-text; disagreements were resolved by consensus. Cohort studies that included histopathological classification among preterm neonates and the outcomes proved eligible. Pooled odds ratios (ORs) with corresponding 95% CIs were calculated for dichotomous outcomes. Random-effects model was also applied in all analyses.
Results: Of 7881 records identified, 22 met the selection criteria and were included in the quantitative analysis. No statistically significant difference was found between the two groups in either outcome, however, there is a tendency with higher incidence of early-, late onset sepsis and bronchopulmonary dysplasia (BPD) among neonates with CA and HFIR.

We managed to conduct a subgroup analysis with an outcome of BPD, and we found significantly elevated incidence (OR 1.31, CI 1.05–1.63) among extremely preterm neonates (born before the 28th gestational week) with concomitant HFIR.
Discussion: Our study shows a significant association between the progression of the intrauterine inflammation towards the fetal direction and BPD among extremely preterm neonates. Additionally, there was a regular tendency in the case of early and late onset sepsis.