Luc Beaudet1, Stella Karuri2, Jacqueline Lau3, Fergall Magee4, Shoo K Lee5, Peter von Dadelszen6. 1. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC. 2. Centre for Healthcare Innovation and Improvement, Child and Family Research Institute, University of British Columbia, Vancouver BC. 3. School of Medicine, Queen's University, Kingston ON. 4. Department of Pathology and Laboratory Medicine and Department of Pediatrics, University of British Columbia, Vancouver BC. 5. Centre for Healthcare Innovation and Improvement, Child and Family Research Institute, University of British Columbia, Vancouver BC; Department of Pathology and Laboratory Medicine and Department of Pediatrics, University of British Columbia, Vancouver BC; Department of Paediatrics, University of Alberta, Edmonton AB. 6. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Centre for Healthcare Innovation and Improvement, Child and Family Research Institute, University of British Columbia, Vancouver BC.
Abstract
BACKGROUND: Placental pathology predicts persistent neurological impairment, even in normally grown infants. However, few studies have linked placental pathology with neonatal outcomes in a large population. METHODS: We 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 > or = grade 3. A forward selection model (10% significance level for entry) was used after adjusting for onfounding factors. RESULTS: A 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. CONCLUSION: Frozen section examination of placentas may facilitate more timely delivery of tailored neonatal therapy.
BACKGROUND: Placental pathology predicts persistent neurological impairment, even in normally grown infants. However, few studies have linked placental pathology with neonatal outcomes in a large population. METHODS: We 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 > or = grade 3. A forward selection model (10% significance level for entry) was used after adjusting for onfounding factors. RESULTS: A 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. CONCLUSION: Frozen section examination of placentas may facilitate more timely delivery of tailored neonatal therapy.
Authors: Roberto Romero; Piya Chaemsaithong; Nikolina Docheva; Steven J Korzeniewski; Juan P Kusanovic; Bo Hyun Yoon; Jung-Sun Kim; Noppadol Chaiyasit; Ahmed I Ahmed; Faisal Qureshi; Suzanne M Jacques; Chong Jai Kim; Sonia S Hassan; Tinnakorn Chaiworapongsa; Lami Yeo; Yeon Mee Kim Journal: J Perinat Med Date: 2016-01 Impact factor: 1.901