NICU.
Department of Developmental Biology, and.
Pediatrics. 2018 Feb;141(2). doi: 10.1542/peds.2017-1788. Epub 2018 Jan 18.
To investigate the relationship between histologic findings of the placenta and response to early postnatal hydrocortisone treatment used to prevent bronchopulmonary dysplasia (BPD) in extremely preterm infants.
In an exploratory analysis of the Early Low-Dose Hydrocortisone to Improve Survival Without Bronchopulmonary Dysplasia in Extremely Preterm Infants (PREMILOC) trial, detailed placental analyses were performed on the basis of standardized macroscopic and histologic examinations. Placental histology, categorized into 3 groups, was correlated to neonatal outcomes and response to hydrocortisone treatment.
Of 523 randomly assigned patients, 457 placentas were analyzed. In total, 125 out of 457 (27%) placentas were classified as normal, 236 out of 457 (52%) placentas were classified as inflammatory, and 96 out of 457 (21%) placentas were classified as vascular. Placental inflammation was associated with a significant, increased rate of BPD-free survival at 36 weeks' postmenstrual age, independent of gestational age, treatment group, and sex (adjusted odds ratio: 1.72, 95% confidence interval [CI]: 1.05 to 2.82, = .03). Regarding the response to treatment, the strongest benefit of hydrocortisone compared with placebo was found in infants born after placental vascular disease, with significantly more patients extubated at day 10 (risk difference: 0.32, 95% CI: 0.08 to 0.56, = .004) and similar positive direction on survival without BPD (risk difference: 0.23, 95% CI: 0.00 to 0.46, = .06). Adjusted to gestational age and treatment groups, placental inflammation was associated with significantly fewer patent ductus arteriosus ligation (adjusted hazard ratio: 0.58, 95% CI: 0.36 to 0.95, = .03). Placental histology was not found to be associated with other adverse events related to preterm birth.
With these findings, we confirm that early low-dose hydrocortisone confers benefits in extremely preterm infants overall and we suggest there is a higher treatment effect in those born after placental vascular disease.
研究胎盘组织学表现与极早产儿接受早期氢化可的松治疗以预防支气管肺发育不良（BPD）反应之间的关系。
在早期低剂量氢化可的松改善极早产儿无支气管肺发育不良生存（PREMILOC）试验的探索性分析中，根据标准化的大体和组织学检查对胎盘进行详细分析。将胎盘组织学分为 3 组，并与新生儿结局和氢化可的松治疗反应相关联。
在 523 例随机分配的患者中，有 457 例胎盘进行了分析。在总共 457 例胎盘中有 125 例（27%）胎盘正常，236 例（52%）胎盘炎症，96 例（21%）胎盘血管。胎盘炎症与 BPD 无生存时间 36 周的显著增加相关，独立于胎龄、治疗组和性别（调整优势比：1.72，95%置信区间[CI]：1.05 至 2.82， =.03）。关于治疗反应，与安慰剂相比，氢化可的松治疗的最大益处是在胎盘血管疾病后出生的婴儿中发现的，在第 10 天拔管的患者明显更多（风险差异：0.32，95%CI：0.08 至 0.56， =.004），且无 BPD 的生存率呈相似的正方向（风险差异：0.23，95%CI：0.00 至 0.46， =.06）。调整胎龄和治疗组后，胎盘炎症与显著较少的动脉导管未闭结扎相关（调整危险比：0.58，95%CI：0.36 至 0.95， =.03）。未发现胎盘组织学与其他与早产相关的不良事件有关。
有了这些发现，我们证实早期低剂量氢化可的松对极早产儿总体有益，并且我们建议在胎盘血管疾病后出生的婴儿中，治疗效果更高。
