Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants – A Matched Case-Control Study

Abstract

Objective

To determine the association of placental pathology with the severity of necrotizing enterocolitis (NEC) in preterm infants.

Methods

This single-center matched case-control study included infants with NEC (n = 107) and gestational age and birth weight-matched controls (n = 130), born between 2013 and 2020. Placentas were evaluated according to the Amsterdam Placental Workshop Group Consensus Statement.

Results

Acute histologic chorioamnionitis with the fetal response was significantly more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). On regression model, infants with multiple placental pathologies (OR 2.16; 95% CI 1.01 − 4.73; p = 0.04) and maternal vascular malperfusion (OR 2.2; 95% CI 1.12 − 4.51; p = 0.02) had higher odds of either medical or surgical NEC than controls.

Conclusion

Infants with multiple placental lesions, including placental inflammatory and vascular lesions, were at higher risk of medical or surgical NEC in the postnatal period.

Keywords:

• Necrotizing enterocolitis
• preterm infants
• placental pathology

Acknowledgment

The Mississippi Clinical and Translational Center (MCCTR) for supporting the NEC research.

Acknowledgments

We would like to thank Dr. Redline from Case Western University and Dr. Suhas G. Kallapur from UCLA Mattel Children’s Hospital for all the guidance for the project. We would also like to thank the Mississippi Center for Clinical/Translational Research for supporting the N.E.C. research.

Conflicts of interest

The authors disclose no conflicts.

Category of study

Clinical science.

Consent

Patient consent is not required as per IRB.

Author contribution

PMG and INM designed the study; PMG, JLP, MAYA, INM, LB, AO, JW, KA, YAH, CR collected and analyzed the data; PMG and INM wrote the manuscript. All the authors contributed to and approved the manuscript.

Additional information

Funding

Dr. Parvesh Garg is partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 5U54GM115428. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by ‘2020 Children’s Clinical Research Advisory Committee (CCRAC) Research Grant’, awarded to Dr. Imran Mir.