Is chorioamnionitis associated with neurodevelopmental outcomes in preterm infants? A systematic review and meta-analysis following PRISMA

BACKGROUND: The relationships between chorioamnionitis (CA) and neurodevelopmental outcomes in preterm infants remain controversial. The meta-analysis aims to evaluate the associations between CA and neurodevelopmental deficits in preterm infants. METHODS: All studies exploring the associations between CA and neurodevelopmental deficits in preterm infants were retrieved from the following databases: PubMed, Embase, OVID, EBSCO, ProQuest, CDSR, and CENTRAL. The NOS was used to evaluate the quality of the studies, RevMan was adopted to analyze the data. RESULTS: Twelve studies involving 4267 preterm infants were included. The ORs across studies was 0.95 (P = .77, I(2) = 51%) for cognitive deficits, 1.09 (P = .44, I(2) = 10%) for psychomotor deficits, 1.21 (P = .08, I(2) = 25%) for language deficits, 2.34 (P = .02, I(2) = 0%) for performance intelligence quotient impairment and 2.81 (P = .03, I(2) = 0%) for verbal intelligence quotient impairment. Subgroup analyses based on the severity of cognitive deficits indicated that CA might be correlated with severe cognitive deficits (P = .01, I(2) = 0%) but not with mild cognitive deficits (P = .40, I(2) = 19%). In terms of the CA category, clinical CA may be related to overall psychomotor deficits (P = .01, I(2) = 25%) and overall language deficits (P < .00001, I(2) = 23%) other than histological CA. CONCLUSION: In preterm infants, CA might be a risk factor for performance and verbal intelligence quotient impairment and severe cognitive deficits, and clinical CA might be a risk factor for overall psychomotor and language deficits.