Document Detail

Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis.
MedLine Citation:
PMID:  10989405     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Chorioamnionitis has been implicated in the pathogenesis of cerebral palsy, but most studies have not reported a significant association. Cystic periventricular leukomalacia (cPVL) is believed to be a precursor of cerebral palsy in preterm infants.
OBJECTIVES: To determine whether chorioamnionitis is associated with cerebral palsy or cPVL and to examine factors that may explain differences in study results.
DATA SOURCES: Searches of MEDLINE (1966-1999), Index Medicus (1960-1965), Doctoral Dissertation Abstracts On-Line (1861-1999), bibliographies, and online conference proceedings (1999) were performed for English-language studies with titles or abstracts that discussed prenatal risk factors for cerebral palsy or cPVL.
STUDY SELECTION: Of 229 initially identified publications, meta-analyses were performed on studies that addressed the association between clinical (n = 19) or histologic (n = 7) chorioamnionitis and cerebral palsy or cPVL in both preterm and full-term infants. Inclusion criteria were: presence of appropriate exposure and outcome measures, case-control or cohort study design, and provision of sufficient data to calculate relative risks (RRs) or odds ratios with 95% confidence intervals (CIs). Studies evaluating risk of cerebral palsy following maternal fever, urinary tract infection, or other maternal infection were collected, but not included in the meta-analysis.
DATA EXTRACTION: Information from individual studies was abstracted using standardized forms by 2 independent observers blinded to authors' names, journal titles, and funding sources.
DATA SYNTHESIS: Using a random effects model, clinical chorioamnionitis was significantly associated with both cerebral palsy (RR, 1.9; 95% CI, 1.4-2.5) and cPVL (RR, 3.0; 95% CI, 2.2-4.0) in preterm infants. The RR of histologic chorioamnionitis and cerebral palsy was 1.6 (95% CI, 0.9-2.7) in preterm infants, and histologic chorioamnionitis was significantly associated with cPVL (RR, 2.1; 95% CI, 1.5-2.9). Among full-term infants, a positive association was found between clinical chorioamnionitis and cerebral palsy (RR, 4.7; 95% CI, 1.3-16.2). Factors explaining differences in study results included varying definitions of clinical chorioamnionitis, extent of blinding in determining exposure status, and whether individual studies adjusted for potential confounders.
CONCLUSION: Our meta-analysis indicates that chorioamnionitis is a risk factor for both cerebral palsy and cPVL. JAMA. 2000;284:1417-1424.
Y W Wu; J M Colford
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  JAMA     Volume:  284     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-10-03     Completed Date:  2000-10-03     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1417-24     Citation Subset:  AIM; IM    
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MeSH Terms
Cerebral Palsy / epidemiology,  etiology*
Chorioamnionitis / complications*
Infant, Newborn
Infant, Premature
Leukomalacia, Periventricular / epidemiology,  etiology*
Risk Factors
Grant Support
5 K12 NS01692-05/NS/NINDS NIH HHS
Comment In:
JAMA. 2000 Dec 20;284(23):2996-7   [PMID:  11122581 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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