Patologia do pensão

Rajeev Mehta, Shakuntala Nanjundaswamy, Susan Shen-Schwarz and Anna Petrova

Department of Pediatrics, Robert Wood Johnson Medical School-University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA

Abstract. 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 ≤ 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). Conclusion : Villous edema and chorionic vasculitis are significant risk factors for the development of the IVH among neonates born at gestational age ≤ 34 weeks. [Indian J Pediatr 2006; 73 (1) : 25-28] E-mail: [e-mail]; [e-mail]

Key words : Preterm infants; Placental pathology; Neonatal morbidity

Placental pathology has been implicated in the None of the studies have assessed the risk for the pathogenesis of preterm neonatal morbidity.1-5 development of common preterm morbidity such as However, the role of placental infection in the retinopathy of prematurity (ROP) and patent ductus occurrence of neurological, lung and infection arteriosus (PDA) in connection with placental lesions morbidity among prematurely born infants remains related to infection and/or pathological events controversial.1, 6 It has been reported that fetal reflecting abnormalities of placental-fetal blood flow. thrombotic vasculopathy7, chorionic plate thrombi8, 9 This study was designed to investigate the villous edema10 and maternal floor infarction11 are association between gestational age, placental responsible for the increased risk of neurological pathology and outcome among preterm births. complications in preterm neonates. Some studies show an association between placental infection and the occurrence of brain damage in neonates,2, 12-19 while MATERIALS AND METHODS others do not support these findings.20-22 Furthermore, there is disagreement regarding the association between The Neonatal Intensive Care Unit (NICU) discharge

chronic lung disease and sepsis in preterm neonates files and placental pathology reports of 165 preterm and in utero exposure to placental infection.3, 23-26 A neonates with gestational age less than 34 weeks and strong association between the degree of prematurity without congenital malformation, admitted to the with preterm morbidity as well as with the types of Tertiary Care NICU at Saint Peter’s University Hospital placental pathology would influence the interpretation from January 1999 to December 2001, were utilized for

of the results. the analysis. The discharge data from the neonatal chart and discharge record is entered by the NICU physician and includes information about the pregnancy, delivery, and neonatal morbidity and mortality.

Correspondence and Reprint requests : Dr. Rajeev Mehta, Associate Professor of Pediatrics, Department of Pediatrics, MEB All placentas were examined by the same senior 348, Robert Wood Johnson Medical School, University of Medicine pathologist who was unaware of the clinical outcome of and Dentistry of New Jersey, One Robert Wood Johnson Place. the infant. The reports were reviewed for evidence of

New Brunswick, NJ, 08903, Fax [phone]. placental abnormalities using standard definitions of

Indian Journal of Pediatrics, Volume 73—January, 2006 25

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Rajeev Mehta et al

commonly described placental pathological lesions.27

Pathological placental findings were linked to the

discharge data using maternal and neonatal charts

numbers as the identifiers. Placental reports were

available for all neonates included in the present study.

The authors acknowledge the possibility of inter-observer

variance and lack of consensus on the diagnosis of

placental lesions. However, because the same pathologist

evaluated all the placentas, it is assumed that all possible

classification errors were equally distributed.

The cause-specific morbidity such as intraventricular

hemorrhage (IVH), periventricular leukomalacia (PVL),

bronchopulmonary dysplasia (BPD), retinopathy of

prematurity (ROP), patent ductus arteriosus (PDA) and

neonatal sepsis was analyzed. IVH and PVL were

diagnosed by cranial ultrasound; BPD was defined as a

requirement for oxygen supplementation at 36 weeks

postmenstrual age; ROP was diagnosed by the standard

eye examination at four to six weeks of age; PDA was

diagnosed using clinical, X-ray and echocardiography

findings; and sepsis was confirmed by bacteriological

positive blood or spinal fluid culture.

For the statistical analysis, all the grades of

chorioamnionitis, IVH and ROP were deemed as either