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Association between viral infection and bronchopulmonary dysplasia in preterm infants: a systematic review and
1Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China.
Insights
Viral infections, particularly cytomegalovirus (CMV), are linked to a higher risk of bronchopulmonary dysplasia (BPD) in preterm infants. Further research is needed to confirm this association and explore prevention strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Infectious Diseases
Background:
- Bronchopulmonary dysplasia (BPD) is a primary complication in very preterm infants (VPI) and very low birth weight (VLBW) infants.
- Viral infections are suspected contributors to BPD development, but evidence remains inconsistent.
Purpose of the Study:
- To systematically review and meta-analyze the association between viral infections and BPD in preterm infants.
- To identify specific viruses implicated in the etiopathogenesis of BPD.
Main Methods:
- Systematic literature search of PubMed, Embase, Web of Science, and Cochrane Database up to December 19, 2023.
- Inclusion of observational studies on viral infections and BPD in preterm infants.
- Risk of bias assessment using the Newcastle-Ottawa Scale (NOS).
Main Results:
- A significant association was found between viral infection and BPD diagnosed at 36 weeks postmenstrual age (OR: 2.42).
- Cytomegalovirus (CMV) showed a significant association with BPD at 36 weeks postmenstrual age (OR: 2.34).
- No significant association was detected for BPD diagnosed on day 28 of life, likely due to small sample sizes.
Conclusions:
- Viral infections, especially CMV, increase the risk of BPD in preterm infants.
- High-quality prospective studies with large samples are necessary to validate these findings.
- Further research, including randomized controlled trials, is needed to evaluate interventions for viral infections in preventing BPD.
Abstract:
Bronchopulmonary dysplasia (BPD) is the most common serious complication of very preterm infants (VPI) or very low birth weight (VLBW) infants. Studies implicate viral infections in etiopathogenesis. The aim of this study was to summarize the relationship between viral infections and BPD through a systematic review and meta-analysis. We searched PubMed, Embase, the Web of Science Core Collection, and the Cochrane Database on December 19, 2023. We included observational studies that examined the association between viral infections and BPD in preterm infants. We extracted data on study methods, participant characteristics, exposure assessment, and outcome measures. We assessed study risk of bias using the Newcastle-Ottawa Scale (NOS). We included 17 and 15 studies in the qualitative review and meta-analysis, respectively. The meta-analysis showed a significant association between viral infection and BPD diagnosed at 36 weeks postmenstrual age (odds ratio (OR): 2.42, 95% confidence interval: 1.89-3.09, 13 studies, very low certainty of evidence). In a subgroup analysis of specific viruses, cytomegalovirus (CMV) proved to be significantly associated with BPD diagnosed at 36 weeks postmenstrual age (OR: 2.34, 95% confidence interval: 1.80-3.05, 11 studies). We did not find an association between viral infection and BPD diagnosed on the 28th day of life, probably due to the small sample size of the included prospective studies. Conclusion: Viral infections, especially CMV, are associated with an increased risk of BPD in preterm infants. Methodologically reliable prospective studies with large samples are needed to validate our conclusions, and high-quality randomized controlled studies are needed to explore the effect of prevention or treatment of viral infections on the incidence of BPD. What is Known: • Studies have attempted to identify viral infections and bronchopulmonary dysplasia in preterm infants; however, results have been inconsistent. What is New: • Systematic demonstration that viral infections, particularly cytomegalovirus, are positively associated with bronchopulmonary dysplasia diagnosed in preterm infants at the 36th week of postmenstrual age. • The importance of screening for viral infections in preterm infants, especially cytomegalovirus. More high-quality studies should be produced in the future to investigate the causal relationship between viral infections and bronchopulmonary dysplasia.
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