Divisions of Pediatric Surgery, University of Stellenbosch, Tygerberg, Western Cape Tygerberg 7505, South Africa.
J Pediatr Surg. 2013 Feb;48(2):359-62. doi: 10.1016/j.jpedsurg.2012.11.020.
Necrotizing enterocolitis (NEC) is the most common and severe acquired acute neonatal surgical condition, associated with premature neonates. Antenatal factors (e.g. vascular insufficiency and antenatal infections) may be important factors in "priming" the inflammatory cascade, thus predisposing to the disease. This study explores the role of placental pathology in predisposing to NEC pathogenesis.
5338 placentas of high risk pregnancies were evaluated for placental insufficiency, infarction, and evidence of antenatal infection. Placentas of 72 premature infants developing surgical NEC (2007-2011) were identified as a separate study group and pathological placental features compared with unaffected infants.
Placentas of 72 of the 134 infants with surgically treated NEC (>grade 2 Bells) were available for pathologic evaluation (the remainder having been referred from other delivery units). Placentas of surgical NEC cases had significantly more evidence of noteworthy vascular pathology (placental infarcts) than high risk cases [n=38 (54.5%) versus n=1122 (21%); P<0.01]. Evidence of placental infection/chorioamnionitis or villitis plus evidence of foetal inflammatory response was present in surgical NEC infants versus unaffected infants [n=22 (31.8%) versus n=647 (12%); P<0.01], suggesting a possible pathogenic role.
This study suggests that exposure to antenatal placental infection may contribute to pathogenesis of NEC by modifying foetal vascular response and warrants further study.
坏死性小肠结肠炎（NEC）是最常见和最严重的获得性急性新生儿外科疾病，与早产儿有关。产前因素（如血管功能不全和产前感染）可能是“引发”炎症级联反应的重要因素，从而易患该病。本研究探讨胎盘病理学在易患 NEC 发病机制中的作用。
评估了 5338 例高危妊娠的胎盘，以评估胎盘功能不全、梗死和产前感染的证据。将 72 例发生手术性 NEC（2007-2011 年）的早产儿的胎盘确定为一个独立的研究组，并与未受影响的婴儿的胎盘病理特征进行比较。
72 例接受手术治疗的 NEC（>2 级贝尔氏）婴儿中有 72 例的胎盘可用于病理评估（其余婴儿来自其他分娩单位）。手术性 NEC 病例的胎盘血管病理学（胎盘梗死）明显比高危病例更明显[n=38（54.5%）与 n=1122（21%）；P<0.01]。手术 NEC 婴儿与未受影响的婴儿相比，胎盘感染/绒毛膜炎或绒毛膜炎加胎儿炎症反应的证据[n=22（31.8%）与 n=647（12%）；P<0.01]，提示可能存在发病机制。
本研究表明，产前胎盘感染的暴露可能通过改变胎儿血管反应而促进 NEC 的发病机制，值得进一步研究。
