Ischemic placental disease as a risk factor for bronchopulmonary dysplasia in extremely preterm infants

Aim

This study aims to investigate the association between placental insufficiency and complications in extremely preterm infants in the context of ischemic placental disease (IPD), including preeclampsia, small-for-gestational-age (SGA), and placental abruption.

Methods

Infants born between 22 and 28 weeks of gestation were classified into IPD and non-IPD groups, matched 1:1 by gestational age and sex. The incidence of neonatal complications was analyzed.

Results

Analysis included 48 infants in each group. The IPD group had a significantly lower birth weight (IPD vs. non-IPD: 679 g vs. 979 g, p < 0.001), whereas the non-IPD group was characterized by a higher prevalence of spontaneous preterm births (12% vs. 79%, p < 0.001) and a significantly higher incidence of histological chorioamnionitis (CAM) (15% vs. 50%, p < 0.001). The IPD group showed a significantly higher incidence of bronchopulmonary dysplasia (BPD) compared to the non-IPD group (85% vs. 48%, p < 0.001), with no significant differences in other complications such as intraventricular hemorrhage, retinopathy of prematurity, and necrotizing enterocolitis. Logistic regression identified IPD as a significant risk factor for BPD (odds ratio [OR] [95% confidence interval]: 9.4 [2.8–31.8], p < 0.001), along with preeclampsia (OR: 4.9 [1.3–18.3], p = 0.01) and SGA (OR: 31.9 [5.9–171], p < 0.001). CAM was not associated with BPD (OR: 0.6 [0.2–1.7], p = 0.45).

Conclusions

Placental insufficiency, manifesting as IPD, is strongly associated with an increased risk of BPD in extremely preterm infants.