Redline Raymond W, Minich Nori, Taylor H Gerry, Hack Maureen
Department of Pathology, Case School of Medicine and Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Cleveland, OH 44106, USA.
Pediatr Dev Pathol. 2007 Jul-Aug;10(4):282-92. doi: 10.2350/06-12-0203.1.
Extremely low birth weight (ELBW) infants (<1 kg) have high rates of neurodisability. Although previous studies have implicated placental lesions in adverse short-term neurologic outcomes in this population, none have assessed their effects in these children once they reach school age. We conducted a secondary analysis of placental pathology in a cohort study of inborn singleton ELBW infants born between 1992 and 1995 and evaluated for cerebral palsy (CP) and abnormal neurocognitive testing at 8 years of age (N = 129). The neurocognitive tests were the Kaufman Assessment Battery for Children (K-ABC) and 6 subtests of the NEPSY: A Developmental Neuropsychological Assessment. We found that placental lesions associated with maternal vascular underperfusion (increased syncytial knots and acute atherosis) were risk factors for CP, while villous edema was associated with low scores on both neurocognitive tests. Histologic chorioamnionitis (HCA) was not predictive of outcome in the population as a whole, but a severe fetal vascular response was associated with a lower NEPSY score in the subpopulation with HCA (N = 69). Placentas with increased syncytial knots, villous edema, and those with neither finding constituted nonoverlapping subgroups with distinct pathologic and perinatal characteristics. Among infants with villous edema (N = 25), those with neurologic impairment had lower gestational ages and more severe degrees of HCA. However, by logistic regression these other factors were not independent risk factors for abnormal neurocognitive testing, and only HCA with a severe fetal vascular response decreased the association of villous edema with low test scores for NEPSY, but not K-ABC.
极低出生体重（ELBW）婴儿（<1千克）的神经残疾发生率很高。尽管先前的研究表明胎盘病变与该人群不良的短期神经学结局有关，但尚无研究评估这些儿童到学龄期时胎盘病变的影响。我们对1992年至1995年间出生的单胎ELBW活产婴儿队列研究中的胎盘病理学进行了二次分析，并在这些婴儿8岁时评估了脑瘫（CP）情况及神经认知测试异常情况（N = 129）。神经认知测试采用考夫曼儿童评估量表（K-ABC）和NEPSY：发育神经心理学评估的6个分测验。我们发现，与母体血管灌注不足相关的胎盘病变（合体结节增加和急性动脉粥样硬化）是CP的危险因素，而绒毛水肿与两项神经认知测试的低分相关。组织学绒毛膜羊膜炎（HCA）对总体人群的结局并无预测作用，但在患有HCA的亚组人群（N = 69）中，严重的胎儿血管反应与较低的NEPSY评分相关。合体结节增加、绒毛水肿的胎盘以及未发现上述情况的胎盘构成了具有不同病理和围产期特征的非重叠亚组。在有绒毛水肿的婴儿（N = 25）中，有神经损伤的婴儿孕周较小，HCA程度更严重。然而，通过逻辑回归分析，这些其他因素并非神经认知测试异常的独立危险因素，只有伴有严重胎儿血管反应的HCA降低了绒毛水肿与NEPSY低测试分数之间的关联，但未降低与K-ABC测试分数之间的关联。
