Abrudan Ana S, Schoots Mirthe H, Kooi Elisabeth M W, Gordijn Sanne J, Kraft Karianne E, Prins Jelmer R, Roescher Annemiek M
Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center, Groningen, The Netherlands.
Department of Pathology and Medical Biology, Pathology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Pediatr Res. 2025 Feb 12. doi: 10.1038/s41390-025-03905-5.
Preterm infants are at risk for neurodevelopmental disabilities later in life, like motor delays and cerebral palsy (CP). The placenta plays a critical role throughout pregnancy, particularly in preterm birth. Our aim is to explore the relation between placental lesions and accurate predictors of neurodevelopmental outcomes in preterm infants.
Preterm infants (<30 weeks and/or birthweight <1000 g) were included with histopathological examination (according to Amsterdam criteria) of the placentas. We predicted the risk for future possible neurodevelopmental impairment using Prechtl's General Movement Assessment to evaluate fidgety movements (FM) at 3 months post-term. We also calculated the Motor Optimality Score-Revised (MOS-R).
In total 78 infants were included. The gestational age ranged from 24.1 to 32.6 weeks and birth weight was between 550 and 1950 g. The presence of AIUI (ascending intrauterine infection) was significantly associated with absent FMs (p = 0.034). Both the presence of fetal and maternal vascular malperfusion (FVM and MVM) were associated with a MOS-R < 23[OR4.58, 95% CI[1.35, 15.55], p = 0.015;OR2.55, 95% CI[1.02, 6.64], p = 0.045).
AIUI is associated with a higher risk of absent FMs and therefore an increased risk for CP. FVM and MVM are significantly associated with MOS-R < 23, which is predictive of an elevated risk for adverse neurodevelopmental (non-CP) outcomes. This finding supports the hypothesis that impaired neurodevelopment in preterm infants already starts before birth.
Our article underscores a key message: neurodevelopmental challenges in preterm infants originate prenatally. Our research has identified a significant association between certain placental lesions and a lower quality of fidgety movements, placing these preterm born infants at a high risk for adverse neurodevelopmental outcomes. To our knowledge, this is the first study to investigate the role of placental pathologies and risk of neurodevelopmental outcomes, while using general movements during the fidgety period. We advocate for neonatologists to integrate placental pathology assessments into their treatment strategies for newborns, recognizing its importance in enhancing care outcomes.
早产儿在日后生活中面临神经发育障碍的风险，如运动发育迟缓及脑瘫（CP）。胎盘在整个孕期发挥着关键作用，尤其是在早产过程中。我们的目的是探究胎盘病变与早产儿神经发育结局准确预测指标之间的关系。
纳入孕周小于30周和/或出生体重小于1000克的早产儿，并对其胎盘进行组织病理学检查（根据阿姆斯特丹标准）。我们使用Prechtl的全身运动评估来评估足月后3个月时的不安运动（FM），以预测未来可能出现神经发育损害的风险。我们还计算了修订后的运动优化评分（MOS-R）。
共纳入78例婴儿。孕周范围为24.1至32.6周，出生体重在550至1950克之间。羊膜腔上行性感染（AIUI）的存在与不安运动缺失显著相关（p = 0.034）。胎儿和母体血管灌注不良（FVM和MVM）的存在均与MOS-R < 23相关[比值比4.58，95%可信区间[1.35，15.55]，p = 0.015；比值比2.55，95%可信区间[1.02，6.64]，p = 0.045]。
AIUI与不安运动缺失风险较高相关，因此CP风险增加。FVM和MVM与MOS-R < 23显著相关，这预示着不良神经发育（非CP）结局风险升高。这一发现支持了早产儿神经发育受损在出生前就已开始的假说。
我们的文章强调了一个关键信息：早产儿的神经发育挑战源于产前。我们的研究已确定某些胎盘病变与不安运动质量较低之间存在显著关联，使这些早产婴儿面临不良神经发育结局的高风险。据我们所知，这是第一项在不安运动期使用全身运动来研究胎盘病理与神经发育结局风险作用的研究。我们主张新生儿科医生将胎盘病理评估纳入其对新生儿的治疗策略中，认识到其在改善护理结局方面的重要性。
