Correlation of placental pathology with the postoperative outcomes and white matter injury in preterm infants following necrotizing enterocolitis

Article type: Research Article

Authors: Garg, P.M.^{a; b; *} | Paschal, J.L.^b | Ansari, M.A.Y.^c | Ware, J.^b | Adams, K.^d | Taylor, C.^e | Reddy, K.^e | Rosenfeld, C.R.^f | Mir, I.N.^f

Affiliations: [a] Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, USA | [b] Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA | [c] Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA | [d] Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA | [e] Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA | [f] Department of Pediatrics/Neonatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

Correspondence: [*] Correspondence to: Parvesh M. Garg, Department of Pediatrics/Neonatology Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, 27157, USA. Tel.: +1 252 3645800; E-mail: [email protected].

Abstract: BACKGROUND:To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS:A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS:In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05–7.54; p = 0.039). CONCLUSION:Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.

Keywords: Necrotizing enterocolitis, preterm infants, placental pathology, white matter injury

DOI: 10.3233/NPM-221105

Journal: Journal of Neonatal-Perinatal Medicine, vol. 16, no. 1, pp. 93-103, 2023