Abstract
Purpose
To investigate the relationship between placental pathology and neurodevelopmental outcomes among extremely low birth weight (ELBW) infants
Methods
Pathology of placentas from ELBW infants born at a tertiary neonatal intensive care unit from January 2007 to December 2012 were reviewed and placental histology was grouped into 3 categories by a designated pathologist: acute chorioamnionitis (ACA), maternal vascular underperfusion (MVU), and control group. Matched ELBW infants were tested for significant neurodevelopmental delays defined as mental developmental index (MDI) or psychomotor developmental index (PDI) <70, using Bayley Scales of Infant Development-II (BSID-II).
Results
The mean gestational age and birth weight of 175 infants were 27.1±2.5 weeks and 764.7±152.3 g respectively. Placental histology revealed MVU (48.0%), ACA (25.1%) and control (26.9%) in distribution. There were less significant patent ductus arteriosus in MVU group than in control group [adjusted odds ratio (OR)=0.331, P=0.011]. The frequencies of other neonatal diseases and mortality were similar in 3 groups. Sixty four of 175 infants were examined for BSID-II at mean corrected 19.9±3.2 months. MVU was associated with significant mental developmental delay (OR=5.185, P=0.036), but after adjustment for head circumference/weight at birth, the statistically significance of association disappeared (adjusted OR=4.391, P=0.075). ACA did not affect neonatal and neurodevelopmental outcomes.
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Fig. 1.
Light microscopic findings of placental lesions. (A)-(C) compatible with amniotic fluid infection. (A) Umbilical vasculitis, a classical fetal inflammatory response (H-E stain, x100). (B) Necrotizing funisitis showing diffuse band of neutrophil debris in the Wharton's jelly (X40). (C) Acute chorioamnionitis of the chorioamniotic membranes, indicative of maternal inflammatory response. There is diffuse infiltration of the maternal neutrophils into the amnion (X200). Figure D-F compatible with maternal vascular underperfusion. (D) Increased syncytial knots. Almost every chorionic villus has syncytial knots (X100). (E) Acute villous infarct showing coagulation necrosis (X100). (F) Increased intervillous fibrin (X100).
![kjp-26-67f1.tif](/upload/SynapseXML/0044kjp/thumb/kjp-26-67f1.gif)
Table 1.
Perinatal characteristics
Characteristics | Control (n=47) | ACA (n=44) | MVU (n=84) | P-value |
---|---|---|---|---|
Gestational age (weeks)∗ | 26.4±2.3 | 25.6±1.2 | 28.2±2.6 | <0.001 |
Birth weight (g)∗ | 766.5±139.2 | 816.9±121.0 | 736.4±167.4 | 0.035 |
SGA, n (%) | 13 (26.5) | 0 (0) | 51 (60.7) | <0.001 |
HC (cm)∗ | 23.8±1.5 | 23.6±1.8 | 24.3±2.0 | 0.025 |
HC <10p, n (%) | 12 (25.0) | 4 (9.5) | 44 (53.0) | <0.001 |
HC/weight (cm/g X100)∗ | 3.2±0.5 | 2.9±0.3 | 3.4±0.8 | <0.001 |
Male, n (%) | 23 (48.9) | 21 (47.7) | 52 (61.9) | 0.211 |
Multiple gestation, n (%) | 31 (63.3) | 17 (38.6) | 30 (35.7) | 0.002 |
Apgar score at 1min∗ | 3.5±1.7 | 3.2±1.5 | 3.9±2.0 | 0.099 |
Apgar score at 5mins∗ | 5.8±1.5 | 5.4±1.4 | 6.3±1.8 | 0.002 |
Initial pH∗ | 7.2±0.1 | 7.2±0.1 | 7.2±0.1 | 0.325 |
Initial base deficit (mmEq/L)∗ | 6.0±4.4 | 7.3±5.0 | 6.8±5.0 | 0.462 |
Lactic acid (mmol/L)∗ | 4.6±2.9 | 4.3±2.8 | 5.8±3.7 | 0.064 |
Cesarean delivery, n (%) | 28 (57.1) | 14 (31.8) | 72 (85.7) | <0.001 |
PPROM > 18hrs, n (%) | 7 (14.3) | 17 (38.6) | 9 (10.7) | <0.001 |
Oligohydramnios | 5 (10.6) | 1 (2.3) | 13 (15.5) | 0.079 |
PIH, n (%) | 2 (4.1) | 1 (2.3) | 28 (33.3) | <0.001 |
Gestational diabetes, n (%) | 2 (4.3) | 0 (0) | 2 (2.4) | 0.474 |
Antenatal corticosteroid, n (%) | 27 (55.1) | 25 (56.8) | 53 (63.1) | 0.789 |
Maternal age (years)∗ | 31.0±4.2 | 33.3±3.3 | 31.5±4.2 | 0.017 |
Maternal education (College) | 37 (78.7) | 36 (81.8) | 61 (72.6) | 0.473 |
Placental weight (g)∗,† | 211.7±69.5 | 249.6±92.6 | 203.6±79.9 | 0.011 |
Placental weight<10p, n (%)† | 8 (53.3) | 10 (37.0) | 51 (80.9) | <0.001 |
Birth weight/placental weight (g/g)∗,† | 3.9±1.4 | 3.6±1.0 | 4.2±1.3 | 0.170 |
Table 2.
Perinatal mortality and morbidity among neonates with acute chorioamnionitis and maternal vascular underperfusion
ACA | MVU | |||||||
---|---|---|---|---|---|---|---|---|
Odds ratio | 95% | % CI | P-value∗ | Odds ratio | 95% | % CI | P-value∗ | |
Mortality | 1.150 | 0.379 | 3.491 | 0.805 | 2.139 | 0.741 | 6.173 | 0.160 |
PDA | 0.468 | 0.190 | 1.151 | 0.098 | 0.331 | 0.141 | 0.778 | 0.011 |
NEC | 0.648 | 0.234 | 1.789 | 0.402 | 0.598 | 0.204 | 1.750 | 0.348 |
Early sepsis | 1.421 | 0.218 | 9.285 | 0.714 | 2.257 | 0.359 | 14.202 | 0.386 |
Late sepsis | 0.962 | 0.385 | 2.403 | 0.934 | 0.561 | 0.235 | 1.341 | 0.193 |
IVH | 0.715 | 0.234 | 2.185 | 0.556 | 0.861 | 0.284 | 2.605 | 0.791 |
PVL | 2.430 | 0.549 | 10.753 | 0.242 | 0.944 | 0.168 | 5.312 | 0.948 |
ROP | 1.916 | 0.579 | 6.334 | 0.287 | 1.688 | 0.478 | 5.965 | 0.416 |
BPD | 0.382 | 0.129 | 1.131 | 0.082 | 0.801 | 0.297 | 2.159 | 0.662 |
Abbreviations: ACA, acute chorioamnionitis; MVU, maternal vascular underperfusion; CI, confidence interval; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; ROP, retinopathy of prematurity; BPD, bronchopulmonary dysplasia
Table 3.
Comparisons of neurodevelopmental delay based on the placental pathology
Table 4.
Neurodevelopmental outcome among neonates with acute chorioamnionitis or maternal vascular underperfusion
Table 5.
Neurodevelopmental outcome among neonates with acute chorioamnionitis or maternal vascular underperfusion after multivariable logistic regression
Developmental index | Placental pathology | Odds ratio | 95% CI | P-value∗ |
---|---|---|---|---|
70≤MDI<85 | Control | 1 | ||
ACA | 1.931 | 0.325 11.476 | 0.469 | |
MVU | 1.845 | 0.398 8.558 | 0.434 | |
MDI<70 | Control | 1 | ||
ACA | Infinite | 0.963 | ||
MVU | 4.391 | 0.863 22.357 | 0.075 | |
70≤PDI<85 | Control | 1 | ||
ACA | 0.619 | 0.082 4.660 | 0.641 | |
MVU | 0.581 | 0.118 2.869 | 0.505 | |
PDI<70 | Control | 1 | ||
ACA | 0.533 | 0.075 3.788 | 0.529 | |
MVU | 0.620 | 0.147 2.612 | 0.515 |