TY - JOUR
T1 - Chorioamnionitis in the development of cerebral palsy
T2 - A meta-analysis and systematic review
AU - Shi, Zhongjie
AU - Ma, Lin
AU - Luo, Kehuan
AU - Bajaj, Monika
AU - Chawla, Sanjay
AU - Natarajan, Girija
AU - Hagberg, Henrik
AU - Tan, Sidhartha
N1 - Funding Information:
Supported in part by grant R01 NS081936 from National Institute of Neurological Disorders and Stroke, National Institutes of Health (to Dr Tan). Funded by the National Institutes of Health (NIH).
Publisher Copyright:
Copyright © 2017 by the American Academy of Pediatrics.
PY - 2017/6
Y1 - 2017/6
N2 - Context: Chorioamnionitis (CA) has often been linked etiologically to cerebral palsy (CP). ObjectiveS: To differentiate association from risk of CA in the development of CP. Data Sources: PubMed, Cochrane Library, Embase, and bibliographies of original studies were searched by using the keywords (chorioamnionitis) AND ((cerebral palsy) OR brain). Study Selection: Included studies had to have: (1) controls, (2) criteria for diagnoses, and (3) neurologic follow-up. Studies were categorized based on: (1) finding incidence of CP in a CA population, or risk of CP; and (2) incidence of CA in CP or association with CP. Data Extraction: Two reviewers independently verified study inclusion and extracted data. Results: Seventeen studies (125 256 CA patients and 5 994 722 controls) reported CP in CA. There was significantly increased CP inpreterm histologic chorioamnionitis (HCA; risk ratio [RR] = 1.34, P < .01), but not in clinical CA (CCA). Twenty-two studies (2513 CP patients and 8135 controls) reported CA in CP. There was increased CCA (RR = 1.43, P < .01), but no increase in HCA in preterm CP. Increased HCA was found (RR = 4.26, P < .05), as well as CCA in term/near-term CP (RR = 3.06, P < .01). Conclusions: The evidence for a causal or associative role of CA in CP is weak. Preterm HCA may be a risk factor for CP, whereas CCA is not. An association with term and preterm CP was found for CCA, but only with term CP for HCA.
AB - Context: Chorioamnionitis (CA) has often been linked etiologically to cerebral palsy (CP). ObjectiveS: To differentiate association from risk of CA in the development of CP. Data Sources: PubMed, Cochrane Library, Embase, and bibliographies of original studies were searched by using the keywords (chorioamnionitis) AND ((cerebral palsy) OR brain). Study Selection: Included studies had to have: (1) controls, (2) criteria for diagnoses, and (3) neurologic follow-up. Studies were categorized based on: (1) finding incidence of CP in a CA population, or risk of CP; and (2) incidence of CA in CP or association with CP. Data Extraction: Two reviewers independently verified study inclusion and extracted data. Results: Seventeen studies (125 256 CA patients and 5 994 722 controls) reported CP in CA. There was significantly increased CP inpreterm histologic chorioamnionitis (HCA; risk ratio [RR] = 1.34, P < .01), but not in clinical CA (CCA). Twenty-two studies (2513 CP patients and 8135 controls) reported CA in CP. There was increased CCA (RR = 1.43, P < .01), but no increase in HCA in preterm CP. Increased HCA was found (RR = 4.26, P < .05), as well as CCA in term/near-term CP (RR = 3.06, P < .01). Conclusions: The evidence for a causal or associative role of CA in CP is weak. Preterm HCA may be a risk factor for CP, whereas CCA is not. An association with term and preterm CP was found for CCA, but only with term CP for HCA.
UR - http://www.scopus.com/inward/record.url?scp=85020168515&partnerID=8YFLogxK
U2 - 10.1542/peds.2016-3781
DO - 10.1542/peds.2016-3781
M3 - Review article
C2 - 28814548
AN - SCOPUS:85020168515
SN - 0031-4005
VL - 139
JO - Pediatrics
JF - Pediatrics
IS - 6
M1 - e20163781
ER -