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105: Histopathological placental features associated with development of periventricular leukomalacia in preterm infants

      Objective

      Periventricular leukomalacia (PVL) is a complication of preterm delivery often leading to cerebral palsy. We seek to identify placental histopathological features that predict the development of PVL in premature infants.

      Study Design

      Case-control study of neonates born from 23 to 34 weeks at a university hospital between 5/94 and 10/04 diagnosed with PVL by ultrasound 6 weeks after birth. Cases were matched by gestational age to controls without PVL. A perinatal pathologist blinded to neonatal course reviewed the placentas. Data were analysed using t-tests and chi square (p<0.05 significant).

      Results

      Cases (n=101) and controls (n=101) were matched by age (27.5±2.6, 27.6±2.5 weeks). Cases had lower birth weight (972±307, 1044±368 grams, p=0.04). There was no difference in cesarean delivery (51.5%, 48.5%), neonatal death (4.0%, 7.9%), umbilical artery pH (7.26±0.10, 7.27±0.12) or base deficit (3.1±4.0, 3.0±4.5 mM).

      Conclusion

      This study suggests an association between chronic placental inflammation and subsequent PVL in infants born prematurely and disagrees with previously reported associations between acute chorioamnionitis and PVL.
      Tabled 1
      PVLControlp value
      Placental wt (g)312±97320±1140.57
      Placental wt/ birthwt0.34±0.110.33±0.120.55
      Acute chorioamnionitis51 (50.5%)51 (50.5%)1.0
      Chronic inflammation26 (25.7%)16 (15.8%)0.04*
      Maternal vascular obstruction48 (47.5%)56 (55.4%)0.26
      Fetal vascular obstruction28 (27.7%)25 (24.8%)0.59
      Fetal vascular disturbance of integrity7 (6.9%)5 (5.0%)0.77
      Perivillous fibrin depositition3 (3.0%)1 (1.0%)0.63
      Increased nucleated RBCs12 (11.9%)8 (7.9%)0.42
      Meconium change4 (4.0%)2 (2.0%)0.69