Abstract
Placental pathology as a predisposing factor to intraventricular hemorrhage remains a matter of debate, and its contribution to cerebellar hemorrhage development is still largely unexplored. Our study aimed to assess placental and perinatal risk factors for intraventricular and cerebellar hemorrhages in preterm infants. This retrospective cohort study included very low-birth weight infants born at the Gaslini Children's Hospital between January 2012 and October 2016 who underwent brain magnetic resonance with susceptibility-weighted imaging at term-equivalent age and whose placenta was analyzed according to the Amsterdam Placental Workshop Group Consensus Statement. Of the 286 neonates included, 68 (23.8%) had intraventricular hemorrhage (all grades) and 48 (16.8%) had a cerebellar hemorrhage (all grades). After correction for gestational age, chorioamnionitis involving the maternal side of the placenta was found to be an independent risk factor for developing intraventricular hemorrhage, whereas there was no association between maternal and fetal inflammatory response and cerebellar hemorrhage. Among perinatal factors, we found that intraventricular hemorrhage was significantly associated with cerebellar hemorrhage (odds ratio [OR], 8.14), mechanical ventilation within the first 72 h (OR, 2.67), and patent ductus arteriosus requiring treatment (OR, 2.6), whereas cesarean section emerged as a protective factor (OR, 0.26). Inotropic support within 72 h after birth (OR, 5.24) and intraventricular hemorrhage (OR, 6.38) were independent risk factors for cerebellar hemorrhage, whereas higher gestational age was a protective factor (OR, 0.76). Assessing placental pathology may help in understanding mechanisms leading to intraventricular hemorrhage, although its possible role in predicting cerebellar bleeding needs further evaluation.
Highlights
Despite significant improvements in the perinatal care of preterm infants, intraventricular hemorrhage (GMH-IVH), and cerebellar hemorrhage (CBH) still represent the most frequent lesions occurring during the very first few days of life [1,2,3]
The aim of our study was to evaluate the role of placental histopathological features in the risk of developing GMH-IVH and CBH, which was diagnosed with brain magnetic resonance imaging (MRI) performed at term-equivalent age (TEA) in a consecutive cohort of very low-birth weight (VLBW) infants
26 (7.5%) patients died before reaching the TEA and one (0.3%) patient was excluded from the study because of the absence of brain MRI
Summary
Despite significant improvements in the perinatal care of preterm infants, intraventricular hemorrhage (GMH-IVH), and cerebellar hemorrhage (CBH) still represent the most frequent lesions occurring during the very first few days of life [1,2,3]. The implementation of magnetic resonance imaging (MRI) with susceptibility-weighted image (SWI) sequences as a diagnostic tool for preterm brain lesions has improved the accuracy in detecting minor forms of both supratentorial and infratentorial hemorrhages [4,5,6,7]. Both GMH-IVH and CBH have a multifactorial etiology [8,9,10], in which gestational age and perinatal factors seem to play a major role, they have never been considered together in relation to placental risk factors. The heterogeneous results in different studies could be explained by the multiplicity of both placental lesion definition and classification
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