Korean J Perinatol.  2015 Mar;26(1):67-77. 10.14734/kjp.2015.26.1.67.

Preliminary Study on Neurodevelopmental Outcome and Placental Pathology among Extremely Low Birth Weight Infants

• Oh SH
• Kim JJ
• Do HJ
• Lee BS
• Kim KS
• Kim EA

• KMID: 2072339
• DOI: http://doi.org/10.14734/kjp.2015.26.1.67

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.
CONCLUSION
The result of placenta biopsy could be a useful tool in counseling parents for future neurodevelopmental outcome, however, further studies are required to define definitive association in between placenta biopsy and neurodevelopmental outcomes.

Keyword

Placenta; Chorioamnionitis; Underperfusion; Neurodevelopmental; Extremely low birth weight

MeSH Terms

Biopsy
Birth Weight
Chorioamnionitis
Counseling
Ductus Arteriosus, Patent
Female
Gestational Age
Head
Humans
Infant*
Infant, Low Birth Weight*
Infant, Newborn
Intensive Care, Neonatal
Mortality
Odds Ratio
Parents
Parturition
Pathology*
Placenta
Pregnancy
Weights and Measures

Figure

• 

  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).

Reference

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