Related Experiment Video
Updated: May 3, 2026
A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development
Published on: June 24, 2020
Chorioamnionitis as a risk factor for retinopathy of prematurity: a systematic review and meta-analysis
Souvik Mitra1, Dagfinn Aune, Christian P Speer
1Department of Paediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway.
Insights
Chorioamnionitis (CA) appears linked to retinopathy of prematurity (ROP) in preterm infants. However, this association weakens when adjusting for gestational age, suggesting CA may not be a definitive ROP risk factor.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Epidemiology
Background:
- Chorioamnionitis (CA) is a placental inflammation with potential implications for preterm infant health.
- The specific role of CA in the development of retinopathy of prematurity (ROP) remains unclear.
- Understanding this association is crucial for identifying and mitigating ROP risk factors.
Purpose of the Study:
- To perform a systematic review and meta-analysis.
- To investigate the association between CA and ROP in preterm infants.
- To synthesize existing evidence on CA as a potential risk factor for ROP.
Main Methods:
- Comprehensive literature search across major databases (MEDLINE, Embase, CINAHL, Cochrane, PubMed).
- Inclusion of studies with comparison groups examining preterm infants and reporting CA-ROP data.
- Data extraction and quality assessment using the Newcastle-Ottawa Scale, with meta-analysis using random effects models.
Main Results:
- Twenty-seven studies involving 10,590 preterm neonates were analyzed.
- Unadjusted analyses indicated a significant association between CA and any stage ROP (RR 1.33) and borderline significant for severe ROP (RR 1.27).
- Subgroup analysis adjusting for gestational age (GA) revealed no significant association between CA and ROP (RR 0.98).
Conclusions:
- While unadjusted data suggest a link between CA and ROP, this association is not supported when controlling for GA.
- CA cannot be definitively established as an independent risk factor for ROP.
- Further research is recommended to adjust for confounding factors and analyze ROP by stage to clarify the relationship.
Background:
The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) has not been well established.
Objective:
To conduct a systematic review and meta-analysis of the association between CA and ROP in preterm infants.
Data Sources:
The authors searched MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and PubMed, reviewed reference lists of relevant articles, abstracts and conference proceedings (Society for Pediatric Research, European Society for Paediatric Research 1990-2012), sought results of unpublished trials, and contacted the primary authors of relevant studies.
Study Selection:
Studies were included if they had a comparison group, examined preterm infants, and reported primary data that could be used to measure the association between exposure to CA and the development of ROP.
Data Extraction:
Two reviewers independently screened the search results, applied inclusion criteria and assessed methodological quality using the Newcastle-Ottawa Scale. One reviewer extracted data and a second reviewer checked data extraction. Summary relative risks (RRs) were calculated using a random effects model.
Data Synthesis:
We identified 1,249 potentially relevant studies from the electronic databases. Twenty-seven studies involving 10,590 preterm neonates with 2,562 cases of ROP were included. Taking into account all included studies without adjusting for gestational age (GA), CA was significantly associated with ROP (any stage) [summary RR 1.33 (95% CI 1.14-1.55, I(2) = 77%, pheterogeneity < 0.0001)], and a borderline significant association was observed for severe ROP (stage ≥3) [summary RR 1.27 (95% CI 0.99-1.63, I(2) = 74%, pheterogeneity < 0.0001)]. There was no publication bias with Begg's test. However, subgroup analysis of studies adjusting for GA showed no significant association on CA with ROP [summary RR 0.98 (95% CI 0.77-1.26, I(2) = 0%, pheterogeneity = 0.89)].
Conclusion:
Unadjusted analyses showed that CA was significantly associated with ROP (any stage) as well as with severe ROP (stage ≥ 3). However, the association disappeared on analysis of studies adjusting for GA. Hence, CA cannot be definitively considered as a risk factor for ROP, and further studies should adjust for potential confounding factors and report results by stage to clarify the association with severe ROP.
Related Concept Videos
01:27Diabetic Retinopathy
01:32The Retina