Neonatal morbidity and placental pathology.
OBJECTIVE
To investigate the association between gestational age, placental pathology and outcome among preterm births.


METHODS
Medical records and placental pathology results of 165 preterm infants (gestational age pound 34 weeks) were used to analyze the development of intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis, in association with placental findings in the gestational age categories of 22-27 (n=71) and 28-33 (n=93) weeks.


RESULTS
Significant differences were found in placental findings based on gestational age and neonatal morbidity. Lower gestational age was associated with increased infection-related lesions such as chorionic vasculitis (47.9%, P< 0.001) and acute chorioamnionitis (67.6%, P< 0.001). Placental lesions reflecting disturbances of fetal-placental blood flow (infarction, chorionic plate thrombi and basal perivillous fibrin) were predominantly seen in the 28-33 week gestational age category (P< 0.05-0.01). Despite the high prevalence of chorioamnionitis (38.8%), no significant association was found between this lesion and the tested preterm morbidity after controlling for gestational age. Only, villous edema and chorionic vasculitis were identified as independent predictors for the development of IVH (49.2%, ORA 2.57, 95% CI 1.01, 6.58 and 39.3%, ORA1.95, 95% CI 1.01, 4.21, respectively).


CONCLUSIONS
Villous edema and chorionic vasculitis are significant risk factors for the development of the IVH among neonates born at gestational age pound 34 weeks.
Mehta
Rajeev
R
Department of Pediatrics, Robert Wood Johnson Medical School-University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey 08903, USA. mehtara@umdnj.edu
Nanjundaswamy
Shakuntala
S
Shen-Schwarz
Susan
S
Petrova
Anna
A
D002821:Chorioamnionitis / Q000209:etiology; D002824:Chorionic Villi / Q000098:blood supply; D004487:Edema / Q000150:complications; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology*; D020300:Intracranial Hemorrhages / Q000209:etiology; D010922:Placenta Diseases; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D012307:Risk Factors; D014657:Vasculitis / Q000150:complications