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Published on: November 20, 2015
Microbiologic and histologic characteristics of the extremely preterm infant's placenta predict white matter damage
Alan Leviton1, Elizabeth N Allred, Karl C K Kuban
1Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Insights
Low-virulence placental microorganisms, including skin flora, predict brain lesions and cerebral palsy (CP) in preterm infants. Placental inflammation also predicts these outcomes, independent of organism recovery.
Area of Science:
- Neonatal neurology
- Perinatal medicine
- Microbiology
Background:
- Inflammatory processes are implicated in perinatal brain damage and cerebral palsy (CP).
- The specific triggers for this inflammation remain largely unknown.
- Understanding these triggers is crucial for preventing adverse neurodevelopmental outcomes in preterm infants.
Purpose of the Study:
- To investigate the association between placental microbial findings and neonatal brain lesions.
- To determine the predictive value of placental inflammation and microbial cultures for neurological outcomes, specifically diparetic CP.
- To explore the interplay between microbial presence and inflammation in predicting brain abnormalities.
Main Methods:
- Analysis of placental biopsies and cultures from 1246 infants born before 28 weeks gestation.
- Cerebral ultrasound scans performed on all infants, with readings by two independent sonologists.
- Neurological examinations conducted at approximately 24 months postterm equivalent for 899 infants.
- Histological examination of placental slides to assess inflammation.
Main Results:
- Recovery of a single microorganism predicted echolucent brain lesions.
- Polymicrobial cultures and skin flora predicted ventriculomegaly and echolucent lesions.
- Single microorganisms, multiple organisms, and skin flora all predicted diparetic CP.
- Histologic inflammation independently predicted ventriculomegaly and diparetic CP.
- The combination of organism recovery and inflammation heightened the risk of ventriculomegaly but not diparetic CP.
Conclusions:
- Low-virulence microorganisms from the placenta, including skin flora, are associated with ultrasound-detected brain lesions and diparetic CP in very preterm infants.
- Placental inflammation can predict diparetic CP even without detectable organism recovery.
- These findings highlight the role of the placental microbiome and inflammatory response in neonatal brain injury and CP development.
Abstract:
Inflammatory phenomena seem to contribute to the occurrence of perinatal cerebral white matter damage and CP. The stimulus that initiates the inflammation remains obscure. One thousand two hundred forty-six infants born before the 28th postmenstrual week had a protocol ultrasound scan of the brain read concordantly by two independent sonologists. Eight hundred ninety-nine of the children had a neurologic examination at approximately 24-mo postterm equivalent. The placenta of each child had been biopsied under sterile conditions and later cultured. Histologic slides of the placenta were examined specifically for this study. Recovery of a single microorganism predicted an echolucent lesion, whereas polymicrobial cultures and recovery of skin flora predicted both ventriculomegaly and an echolucent lesion. Diparetic CP was predicted by recovery of a single microorganism, multiple organisms, and skin flora. Histologic inflammation predicted ventriculomegaly and diparetic CP. The risk of ventriculomegaly associated with organism recovery was heightened when accompanied by histologic inflammation, but the risk of diparetic CP was not. Low-virulence microorganisms isolated from the placenta, including common skin microflora, predict ultrasound lesions of the brain and diparetic CP in the very preterm infant. Organism recovery does not seem to be needed for placenta inflammation to predict diparetic CP.
