Correlation of in situ detection of infectious agents in the placenta with neonatal outcome.
OBJECTIVE
To determine if infections involving the placenta are associated with unexplained systemic illness in the newborn infant and subsequent poor neonatal outcome (death or significant neurodevelopmental abnormalities).


METHODS
Placental tissue from 33 newborn infants with systemic illness and poor neonatal outcome were tested by in situ hybridization or reverse transcriptase-polymerase chain reaction for infectious pathogens. Control placentas came from mothers delivering infants with poor neonatal outcome of known cause (ie, cord prolapse, uterine rupture), mothers with known infections, and normal births (n=21).


RESULTS
There were 5 deaths among the newborn infants, and all survivors had poor neonatal outcome. Placentas from 24 of 33 cases (73%) had positive test results for Coxsackie virus (46%), bacteria (38%), herpes (8%), and parvovirus (4%) and picornavirus (4%). At autopsy, multiple organs from the newborn infant had positive test results for the same organism isolated from the placenta. No infectious agents were detected in the control infants, except those from mothers with known infections.


CONCLUSIONS
In utero infection of the placenta is associated with systemic illness in the newborn infant and poor neonatal outcome. These results emphasize the importance of pathologic and molecular examination of the placenta in critically ill newborn infants.
Department of Pediatrics, Winthrop University Hospital, SUNY Stony Brook School of Medicine, Mineola, New York 11501, USA. jdavis@winthrop.org
Linda
L
Genen
Gerard J
GJ
Nuovo
Leonard
L
Krilov
Jonathan M
JM
Davis
D000328:Adult; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000382:microbiology*; D010920:Placenta / Q000382:microbiology*; D010922:Placenta Diseases / Q000150:complications*; D011247:Pregnancy; D011256:Pregnancy Outcome; D020133:Reverse Transcriptase Polymerase Chain Reaction