Background To determine the association of placental pathology, including multiple placental lesions, with the occurrence and severity of bronchopulmonary dysplasia (BPD), death, and neurodevelopmental impairment (NDI) in preterm infants. Method A retrospective cohort study of neonates <29 weeks gestational age (GA) born at Parkland Hospital from 08/2009 to 08/2012. Infants were stratified as follows: Group 1: no significant placental pathology; Group 2: single significant placental lesion; and Group 3: ≥2 placental lesions (multiple lesions). Primary outcome was death and/or BPD. Two-year neurodevelopmental follow-up was compared. Results In all, 42% (100/241) of infants had one placental lesion, and 34% (82/241) ≥2 lesions. As the number of the pathologic lesions increased (no lesions vs. 1 vs. ≥2), the occurrence of death or BPD increased (25%, 37%, and 52%, respectively; P = 0.004). Moreover, infants with multiple pathologic lesions were more likely to have NDI (29%, 29%, and 46%, respectively; P = 0.03). After logistic regression, infants with multiple pathologic lesions were more likely to develop moderate-to-severe BPD [ P < 0.01; OR 3.9 (1.5–10.1)] but not NDI. Conclusion(s) Neonates <29 weeks GA with multiple placental pathologic lesions have an increased risk for developing BPD, suggesting an interaction between placental inflammation and vascular pathology and the pathogenesis of BPD; however, the risk of NDI is not increased.

中文翻译：

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多种胎盘病理对早产儿新生儿死亡、支气管肺发育不良和神经发育障碍的影响

背景 确定胎盘病理，包括多处胎盘病变，与早产儿支气管肺发育不良 (BPD)、死亡和神经发育障碍 (NDI) 的发生和严重程度之间的关联。方法 一项对 2009 年 8 月至 2012 年 8 月在帕克兰医院出生的小于 29 周胎龄 (GA) 新生儿的回顾性队列研究。婴儿分层如下： 第 1 组：无显着胎盘病理；第 2 组：单个显着胎盘病变；和第 3 组：≥2 个胎盘病变（多处病变）。主要结果是死亡和/或 BPD。比较了两年的神经发育随访。结果 总共有 42% (100/241) 的婴儿有 1 个胎盘病变，34% (82/241) ≥ 2 个病变。随着病理病变数量的增加（无病变 vs. 1 vs. ≥2），死亡或 BPD 的发生率增加（分别为 25%、37% 和 52%；P = 0.004）。此外，有多处病理病变的婴儿更可能患有 NDI（分别为 29%、29% 和 46%；P = 0.03）。Logistic 回归后，多发病理性病变的婴儿更易发生中重度 BPD [ P < 0.01；OR 3.9 (1.5–10.1)] 但不是 NDI。结论 (s) 出生 29 周以下的新生儿有多个胎盘病理性病变发生 BPD 的风险增加，表明胎盘炎症和血管病理以及 BPD 的发病机制之间存在相互作用；然而，NDI 的风险并没有增加。有多个病理病变的婴儿更容易发生中重度 BPD [ P < 0.01; OR 3.9 (1.5–10.1)] 但不是 NDI。结论 (s) 出生 29 周以下的新生儿有多个胎盘病理性病变发生 BPD 的风险增加，表明胎盘炎症和血管病理以及 BPD 的发病机制之间存在相互作用；然而，NDI 的风险并没有增加。有多个病理病变的婴儿更容易发生中重度 BPD [ P < 0.01; OR 3.9 (1.5–10.1)] 但不是 NDI。结论 (s) 出生 29 周以下的新生儿有多个胎盘病理性病变发生 BPD 的风险增加，表明胎盘炎症和血管病理以及 BPD 的发病机制之间存在相互作用；然而，NDI 的风险并没有增加。