Background

We analyzed the certainty of evidence (CoE) for risk factors of periventricular leukomalacia (PVL) in preterm neonates, a common morbidity of prematurity.

Methods

Medline, CENTRAL, Embase, and CINAHL were searched. Cohort and case-control studies and randomised randomized controlled trials were included. Data extraction was performed in duplicate. A random random-effects meta-analysis was utilizedused. CoE was evaluated as per Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Results

One hundred eighty-six studies evaluating 95 risk factors for PVL were included. Of the 2,509,507 neonates assessed, 16,569 were diagnosed with PVL. Intraventricular hemorrhage [adjusted odds ratio: 3.22 (2.52-4.12)] had moderate CoE for its association with PVL. Other factors such as hypocarbia, chorioamnionitis, PPROM >48 h, multifetal pregnancy reduction, antenatal indomethacin, lack of antenatal steroids, perinatal asphyxia, ventilation, shock/hypotension, patent ductus arteriosus requiring surgical ligation, late-onset circulatory collapse, sepsis, necrotizing enterocolitis, and neonatal surgery showed significant association with PVL after adjustment for confounders (CoE: very low to low). Amongst the risk factors associated with mother placental fetal (MPF) triad, there was paucity of literature related to genetic predisposition and defective placentation. Sensitivity analysis revealed that the strength of association between invasive ventilation and PVL decreased over time (P < 0.01), suggesting significant progress in ventilation strategies. Limited studies had evaluated diffuse PVL.

Conclusion

Despite decades of research, our findings indicate that the CoE is low to very low for most of the commonly attributed risk factors of PVL. Future studies should evaluate genetic predisposition and defective placentation in the MPF triad contributing to PVL. Studies evaluating exclusively diffuse PVL are warranted.

中文翻译：

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早产儿脑室周围白质软化的危险因素：系统评价、荟萃分析和基于 GRADE 的证据确定性评估

背景

我们分析了早产儿脑室周围白质软化症 (PVL) 风险因素的证据确定性 (CoE)，这是一种常见的早产儿疾病。

方法

检索了 Medline、CENTRAL、Embase 和 CINAHL。包括队列和病例对照研究以及随机随机对照试验。数据提取一式两份进行。使用了随机随机效应荟萃分析。CoE 根据建议分级评估、开发和评估 (GRADE) 指南进行了评估。

结果

纳入了 186 项评估 PVL 的 95 个危险因素的研究。在评估的 2,509,507 名新生儿中，有 16,569 名被诊断患有 PVL。脑室内出血 [调整优势比：3.22 (2.52-4.12)] 与 PVL 相关的 CoE 中等。其他因素如低碳酸血症、绒毛膜羊膜炎、PPROM >48 小时、多胎妊娠减少、产前消炎痛、缺乏产前类固醇、围产期窒息、通气、休克/低血压、需要手术结扎的动脉导管未闭、迟发性循环衰竭、败血症、坏死在调整混杂因素后，小肠结肠炎和新生儿手术与 PVL 显着相关（CoE：非常低到低）。在与母亲胎盘胎儿 (MPF) 三联征相关的危险因素中，缺乏与遗传易感性和胎盘缺陷相关的文献。敏感性分析显示，有创通气与 PVL 之间的关联强度随着时间的推移而降低（P  < 0.01），表明通风策略取得了重大进展。有限的研究评估了弥漫性 PVL。

结论

尽管进行了数十年的研究，但我们的研究结果表明，对于大多数常见的 PVL 风险因素，CoE 从低到非常低。未来的研究应评估 MPF 三联征中导致 PVL 的遗传易感性和胎盘缺陷。有必要进行专门评估弥漫性 PVL 的研究。