Placental Pathology and Clinical Outcomes in a Cohort of Infants Admitted to a Neonatal Intensive Care Unit

Abstract

BackgroundPlacental pathology predicts persistent neurological impairment, even in normally grown infants. However, few studies have linked placental pathology with neonatal outcomes in a large population. MethodsWe matched the clinical outcomes of a cohort of neonates admitted to a neonatal intensive care unit (NICU) with placental pathology, where available, and examined (by multivariable logistic regression) the relationship between placental pathologies and these outcomes. The outcomes included neonatal death, necrotizing enterocolitis, and intraventricular hemorrhage ≥ grade 3. A forward selection model (10% significance level for entry) was used after adjusting for confounding factors. ResultsA detailed gross and microscopic pathological report was available for 1296 eligible infants (64%). Specific placental features were associated with specific neonatal outcomes. The Canadian Neonatal Network has previously determined that specific changes in the pattern of neonatal care can alter the incidence and severity of these outcomes. In the placentas from pregnancies delivering small for gestational age infants who were subsequently admitted to NICU, two different patterns of placental pathologies were found, one ischemic and the other inflammatory. ConclusionFrozen section examination of placentas may facilitate more timely delivery of tailored neonatal therapy.