通过胎盘评估母体和胎儿血管灌注不良情况,加强早产儿视网膜病变的风险评估。

IF 5 2区 医学 Q1 OPHTHALMOLOGY
Salma El Emrani, Esther J S Jansen, Jelle J Goeman, Jacqueline U M Termote, Enrico Lopriore, Nicoline E Schalij-Delfos, Lotte E van der Meeren
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引用次数: 0

摘要

目的:确定子宫胎盘灌注不良对早产儿视网膜病变(ROP)发生的独立影响:这项队列研究包括 591 名胎龄(GA)≤ 32 周或出生体重(BW)≤ 1500 克的新生儿、胎盘剥离、梗塞、远端绒毛发育不良、缺血和蜕膜坏死)和胎儿血管灌注不良(如血栓形成、胎儿缺氧和实质水肿)。主要结果为 ROP。次要结果包括胎儿性别、体重、胎龄小(SGA)、机械通气持续时间、产后皮质类固醇、败血症和坏死性小肠结肠炎:除胎盘早剥与较低的 SGA 发生率相关外,母体血管灌注不良与较高的 GA、较低的体重和较高的 SGA 发生率相关。胎儿血管灌注不良与较低的体重、较高的 SGA 率和较短的机械通气时间有关。对无炎症胎盘的分组分析表明,患有早产儿视网膜病变的新生儿远端绒毛发育不全(44% 对 31%)和实质水肿(7% 对 0%)的发生率增加。多变量回归分析显示,三个胎盘因素与 ROP 独立相关:远端绒毛发育不良(OR = 1.7;95% CI,1.0-3.0)、严重急性组织学绒毛膜羊膜炎(OR = 2.1;95% CI,1.1-3.9)和真菌炎(OR = 1.8;95% CI,1.0-3.1):结论:对远端绒毛发育不全、严重急性绒毛膜羊膜炎和真菌炎进行胎盘评估是对早产儿视网膜病变风险分析的一种新的有价值的补充。在婴儿出生后不久对这些胎盘风险因素进行评估,有助于比目前更早地识别高风险婴儿。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Enhancing the Retinopathy Of Prematurity Risk Profile Through Placental Evaluation of Maternal and Fetal Vascular Malperfusion.

Purpose: To determine the independent effect of uteroplacental malperfusion on the development of retinopathy of prematurity (ROP).

Methods: This cohort study included 591 neonates with a gestational age (GA) ≤ 32 weeks or birthweight (BW) ≤ 1500 g. Clinical data was retrospectively collected and placentas were prospectively examined for maternal vascular malperfusion (e.g., abruption, infarct, distal villous hypoplasia, ischemia, and decidual necrosis) and fetal vascular malperfusion (e.g., thrombosis, fetal hypoxia, and hydrops parenchyma). The primary outcome was ROP. Secondary outcomes were GA, BW, small for gestational age (SGA), mechanical ventilation duration, postnatal corticosteroids, sepsis, and necrotizing enterocolitis.

Results: Maternal vascular malperfusion was associated with higher GA, lower BW, and increased SGA rates, except placental abruption, which was associated with lower SGA rates. Fetal vascular malperfusion was associated with lower BW, increased SGA rates and lower duration of mechanical ventilation. Subgroup analysis of placentas without inflammation showed increased rates of distal villous hypoplasia (44% vs. 31%) and hydrops parenchyma (7% vs. 0%) in neonates with ROP. Multivariate regression analyses revealed three placenta factors to be independently associated with ROP: distal villous hypoplasia (OR = 1.7; 95% CI, 1.0-3.0), severe acute histological chorioamnionitis (OR = 2.1; 95% CI, 1.1-3.9) and funisitis (OR = 1.8; 95% CI, 1.0-3.1).

Conclusions: Placental evaluation of distal villous hypoplasia, severe acute chorioamnionitis and funisitis is a novel and valuable addition to the ROP risk profile. Evaluation of these placental risk factors shortly after birth can aid in identifying high-risk infants in an earlier stage than currently possible.

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来源期刊
CiteScore
6.90
自引率
4.50%
发文量
339
审稿时长
1 months
期刊介绍: Investigative Ophthalmology & Visual Science (IOVS), published as ready online, is a peer-reviewed academic journal of the Association for Research in Vision and Ophthalmology (ARVO). IOVS features original research, mostly pertaining to clinical and laboratory ophthalmology and vision research in general.
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