Abstract
Purpose :
Adequate placental development is crucial for favorable short- and long-term outcomes in neonates. To date, the role of impaired placental development in the development of retinopathy of prematurity (ROP) has not been thoroughly investigated. The aim of this retrospective cohort study was to determine the independent effect of placenta pathology on ROP to identify infants at high risk for ROP shortly after birth.
Methods :
This study included 594 neonates born <32 weeks of gestational age (GA) and/or with a birthweight (BW) <1500 grams, of whom 166 had ROP. Neonates were excluded when their placentas were unavailable for histological examination. Clinical data was retrospectively collected and placentas were prospectively examined by a pathologist for acute and chronic placental inflammation (e.g. chorioamnionitis and funisitis), and maternal and fetal vascular malperfusion (e.g. distal villous hypoplasia). Outcomes explored were GA, BW, small for gestational age, mechanical ventilation duration, postnatal corticosteroids, sepsis, necrotizing enterocolitis and ROP. Uni- and multivariate regression analyses were performed.
Results :
Neonates with ROP had increased rates of severe acute chorioamnionitis (42% vs. 21%, p<0.001), funisitis (61% vs. 35%, p<0.001) and distal villous hypoplasia (44% vs. 31%, p=0.034). Univariate regression analysis showed increased odds for ROP in neonates with lower GA, lower BW, longer mechanical ventilation duration, postnatal steroid use and sepsis (p≤0.002). Multivariate regression analyses revealed three placenta factors to be independently associated with ROP: severe acute chorioamnionitis (OR 2.1; 95% CI 1.1–4.0), funisitis (OR 1.8; 95% CI 1.0–3.1) and distal villous hypoplasia (OR 1.8; 95% CI 1.0–3.0).
Conclusions :
Structured placental evaluation of acute chorioamnionitis, funisitis and distal villous hypoplasia is a novel and valuable addition to predicting the development of ROP. Evaluation of these placental risk factors shortly after birth can aid in identifying high-risk infants in an earlier stage than currently possible.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.