TY - JOUR
T1 - Enhancing the Retinopathy Of Prematurity Risk Profile Through Placental Evaluation of Maternal and Fetal Vascular Malperfusion
AU - El Emrani, Salma
AU - Jansen, Esther J.S.
AU - Goeman, Jelle J.
AU - Termote, Jacqueline U.M.
AU - Lopriore, Enrico
AU - Schalij-Delfos, Nicoline E.
AU - van der Meeren, Lotte E.
N1 - Publisher Copyright: Copyright 2024 The Authors.
PY - 2024/9
Y1 - 2024/9
N2 - PURPOSE. To determine the independent effect of uteroplacental malperfusion on the development of retinopathy of prematurity (ROP). METHODS. This cohort study included 591 neonates with a gestational age (GA) ≤ 32 weeks or birthweight (BW) ≤ 1500 g. Clinical data was retrospectively collected and placentas were prospectively examined for maternal vascular malperfusion (e.g., abruption, infarct, distal villous hypoplasia, ischemia, and decidual necrosis) and fetal vascular malperfusion (e.g., thrombosis, fetal hypoxia, and hydrops parenchyma). The primary outcome was ROP. Secondary outcomes were GA, BW, small for gestational age (SGA), mechanical ventilation duration, postnatal corticosteroids, sepsis, and necrotizing enterocolitis. RESULTS. Maternal vascular malperfusion was associated with higher GA, lower BW, and increased SGA rates, except placental abruption, which was associated with lower SGA rates. Fetal vascular malperfusion was associated with lower BW, increased SGA rates and lower duration of mechanical ventilation. Subgroup analysis of placentas without inflammation showed increased rates of distal villous hypoplasia (44% vs. 31%) and hydrops parenchyma (7% vs. 0%) in neonates with ROP. Multivariate regression analyses revealed three placenta factors to be independently associated with ROP: distal villous hypoplasia (OR = 1.7; 95% CI, 1.0–3.0), severe acute histological chorioamnionitis (OR = 2.1; 95% CI, 1.1–3.9) and funisitis (OR = 1.8; 95% CI, 1.0–3.1). CONCLUSIONS. Placental evaluation of distal villous hypoplasia, severe acute chorioamnionitis and funisitis is a novel and valuable addition to the ROP risk profile. Evaluation of these placental risk factors shortly after birth can aid in identifying high-risk infants in an earlier stage than currently possible.
AB - PURPOSE. To determine the independent effect of uteroplacental malperfusion on the development of retinopathy of prematurity (ROP). METHODS. This cohort study included 591 neonates with a gestational age (GA) ≤ 32 weeks or birthweight (BW) ≤ 1500 g. Clinical data was retrospectively collected and placentas were prospectively examined for maternal vascular malperfusion (e.g., abruption, infarct, distal villous hypoplasia, ischemia, and decidual necrosis) and fetal vascular malperfusion (e.g., thrombosis, fetal hypoxia, and hydrops parenchyma). The primary outcome was ROP. Secondary outcomes were GA, BW, small for gestational age (SGA), mechanical ventilation duration, postnatal corticosteroids, sepsis, and necrotizing enterocolitis. RESULTS. Maternal vascular malperfusion was associated with higher GA, lower BW, and increased SGA rates, except placental abruption, which was associated with lower SGA rates. Fetal vascular malperfusion was associated with lower BW, increased SGA rates and lower duration of mechanical ventilation. Subgroup analysis of placentas without inflammation showed increased rates of distal villous hypoplasia (44% vs. 31%) and hydrops parenchyma (7% vs. 0%) in neonates with ROP. Multivariate regression analyses revealed three placenta factors to be independently associated with ROP: distal villous hypoplasia (OR = 1.7; 95% CI, 1.0–3.0), severe acute histological chorioamnionitis (OR = 2.1; 95% CI, 1.1–3.9) and funisitis (OR = 1.8; 95% CI, 1.0–3.1). CONCLUSIONS. Placental evaluation of distal villous hypoplasia, severe acute chorioamnionitis and funisitis is a novel and valuable addition to the ROP risk profile. Evaluation of these placental risk factors shortly after birth can aid in identifying high-risk infants in an earlier stage than currently possible.
UR - http://www.scopus.com/inward/record.url?scp=85203305215&partnerID=8YFLogxK
U2 - 10.1167/iovs.65.11.9
DO - 10.1167/iovs.65.11.9
M3 - Article
C2 - 39230991
AN - SCOPUS:85203305215
SN - 0146-0404
VL - 65
JO - Investigative Ophthalmology and Visual Science
JF - Investigative Ophthalmology and Visual Science
IS - 11
M1 - 9
ER -