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Impact of multiple placental pathologies on neonatal death, bronchopulmonary dysplasia, and neurodevelopmental impairment in preterm infants
Pediatric Research ( IF 3.1 ) Pub Date : 2019-12-07 , DOI: 10.1038/s41390-019-0715-y
Imran N Mir 1 , Lina F Chalak 1 , L Steven Brown 2 , Sarah Johnson-Welch 3 , Roy Heyne 1 , Charles R Rosenfeld 1 , Vishal S Kapadia 1
Affiliation  

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:

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。
更新日期:2019-12-07
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