Open Access, Peer-reviewed
pISSN 2508-4887
eISSN 2508-4895
    Korean J Perinatol. 2015 Mar;26(1):67-77. Korean.
    Published online Mar 31, 2015.
    https://doi.org/10.14734/kjp.2015.26.1.67
    Copyright © 2015 The Korean Society of Perinatology
    Original Article

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

    Seong-Hee Oh, M.D.,1 Jong-jae Kim, M.D., Ph.D.,2 Hyun-jeong Do, M.D.,1 Byong Sop Lee, M.D., Ph.D.,1 Ki-Soo Kim, M.D., Ph.D.,1 and Ellen Ai-Rhan Kim, M.D., Ph.D.1
      • 1Division of Neonatology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
      • 2Department of Pathology, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
    • Correspondence to: Ellen Ai-Rhan Kim, M.D., Division of Neona tology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, South Korea. Tel: +82-2-3010-3382, Fax: +82-2-3010-6978, Email: arkim@amc.seoul.kr
    Received February 17, 2015; Revised February 28, 2015; Accepted February 28, 2015.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    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.

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

    Figures

    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, ×100). (B) Necrotizing funisitis showing diffuse band of neutrophil debris in the Wharton's jelly (×40). (C) Acute chorioamnionitis of the chorioamniotic membranes, indicative of maternal inflammatory response. There is diffuse infiltration of the maternal neutrophils into the amnion (×200). Figure D-F compatible with maternal vas cular underperfusion. (D) Increased syncytial knots. Almost every chorionic villus has syncytial knots (×100). (E) Acute villous infarct showing coagulation necrosis (×100). (F) Increased intervillous fibrin (×100).

    Tables

    Table 1
    Perinatal characteristics

    Table 2
    Perinatal mortality and morbidity among neonates with acute cho rioamnionitis and maternal vascular underperfusion

    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

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    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
    Metrics
    Share
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