Chorioamnionitis and Risk for Maternal and Neonatal Sepsis: A Systematic Review and Meta-analysis.
Chorioamnionitis and Risk for Maternal and Neonatal Sepsis: A Systematic Review and Meta-analysis.
复制标题
绒毛膜炎与孕产妇和新生儿败血症的风险：系统性综述和荟萃分析。
DOI：
10.1097/aog.0000000000004377
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发表时间：
2021-06-01
影响因子：
7.2
通讯作者：
Gernand AD
中科院分区：
文献类型：
--
作者：
Beck C;Gallagher K;Taylor LA;Goldstein JA;Mithal LB;Gernand AD
评估与绒毛膜炎相关的母亲和新生儿败血症的风险。系统性检索PubMed、BIOSIS和www.example.com数据库，以获取从开始到2020年5月11日的英文全文文章。我们筛选了1，251项研究。随机对照试验，病例对照，或队列研究定量绒毛膜炎和败血症之间的关系，母亲（产后）或婴儿出生> 22周的妊娠是合格的。根据组织学或临床绒毛膜炎的暴露以及母体或新生儿败血症的结局，对研究进行荟萃分析（）。纳入了103项研究，其中55项符合荟萃分析的标准（39项早产儿研究，10项早产儿和足月儿一般人群研究，6项晚期早产儿和足月儿研究）。提取研究细节和定量数据。使用随机效应模型生成合并OR;大多数研究仅报告未校正的结果。组织学绒毛膜炎与确诊的和任何早发性新生儿败血症相关（未校正的合并OR分别为4.42（95% CI，2.68 - 7.29）和5.88（95% CI，3.68 - 9.41））。临床绒毛膜炎也与确诊的和任何早发性新生儿败血症相关（未校正的合并OR分别为6.82（95% CI，4.93 - 9.45）和3.90（95% CI，2.74 - 5.55））。此外，组织学和临床绒毛膜炎均与早产儿迟发性脓毒症的几率较高相关。经证实的脓毒症发病率为7%（早发）和22%（晚发）的组织学和6%（早发）和26%（晚发）的临床绒毛膜炎暴露的婴儿。3项研究评价了绒毛膜炎和母体败血症，但尚无结论。组织学和临床绒毛膜炎均与新生儿早发型和晚发型脓毒症有关。总的来说，我们的研究结果支持目前的新生儿预防性护理指南。没有足够的证据来确定绒毛膜炎和母体败血症之间的关系。PROSPERO，CRD 42020156812。绒毛膜炎与早发性和晚发性新生儿败血症相关，足月儿或母体败血症的证据有限。
To estimate the risk of maternal and neonatal sepsis associated with chorioamnionitis. PubMed, BIOSIS, and clinicaltrials.gov databases were systematically searched for full-text articles in English from inception until May 11, 2020. We screened 1,251 studies. Randomized controlled trials, case-control, or cohort studies quantifying a relationship between chorioamnionitis and sepsis in mothers (postpartum) or infants born >22 weeks gestation were eligible. Studies were grouped for meta-analyses according to exposures of histological or clinical chorioamnionitis and outcomes of maternal or neonatal sepsis (). One hundred three studies were included, and 55 met criteria for meta-analysis (39 studies of preterm infants, 10 studies of general populations of preterm and term infants, and 6 studies of late preterm and term infants). Study details and quantitative data were abstracted. Random-effects models were used to generate pooled ORs; most studies only reported unadjusted results. Histological chorioamnionitis was associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 4.42 (95% CI, 2.68–7.29) and 5.88 (95% CI, 3.68–9.41), respectively). Clinical chorioamnionitis was also associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 6.82 (95% CI, 4.93–9.45) and 3.90 (95% CI, 2.74–5.55), respectively). Additionally, histological and clinical chorioamnionitis were each associated with higher odds of late-onset sepsis in preterm infants. Confirmed sepsis incidence was 7% (early-onset) and 22% (late-onset) for histological and 6% (early-onset) and 26% (late-onset) for clinical chorioamnionitis exposed infants. Three studies evaluated chorioamnionitis and maternal sepsis and were inconclusive. Both histological and clinical chorioamnionitis were associated with early- and late-onset sepsis in neonates. Overall, our findings support current guidelines for preventative neonatal care. There was insufficient evidence to determine the association between chorioamnionitis and maternal sepsis. PROSPERO, CRD42020156812. Chorioamnionitis is associated with early-onset and late-onset neonatal sepsis, with limited evidence for term infants or maternal sepsis.