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Published on: November 20, 2015
Placental pathology is associated with lower quality fidgety movements in preterm infants
Ana S Abrudan1, Mirthe H Schoots2, Elisabeth M W Kooi3
1Division of Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center, Groningen, The Netherlands. a.s.abrudan@umcg.nl.
Insights
Placental lesions like ascending intrauterine infection (AIUI) are linked to absent fidgety movements (FM) and increased cerebral palsy risk in preterm infants. Fetal and maternal vascular malperfusion also predict poorer neurodevelopmental outcomes.
Area of Science:
- Neonatology
- Perinatology
- Developmental Neuroscience
Background:
- Preterm infants face significant risks for neurodevelopmental disabilities, including motor delays and cerebral palsy (CP).
- The placenta is crucial for fetal development, and its pathologies are implicated in preterm birth complications.
- Understanding placental lesions' impact is vital for predicting and mitigating neurodevelopmental impairments in high-risk infants.
Purpose of the Study:
- To investigate the association between specific placental lesions and neurodevelopmental outcomes in preterm infants.
- To identify placental pathologies as predictors of motor delays and cerebral palsy (CP).
- To explore the relationship between placental examination findings and early markers of neurodevelopmental impairment.
Main Methods:
- Histopathological examination of placentas from preterm infants (<30 weeks and/or <1000g birthweight) using Amsterdam criteria.
- Assessment of neurodevelopmental outcomes via Prechtl's General Movement Assessment (GMA) for fidgety movements (FM) at 3 months post-term.
- Calculation of the Motor Optimality Score-Revised (MOS-R) to evaluate neurodevelopmental status.
Main Results:
- Ascending intrauterine infection (AIUI) was significantly associated with absent fidgety movements (p=0.034).
- Fetal and maternal vascular malperfusion (FVM and MVM) were linked to a Motor Optimality Score-Revised (MOS-R) < 23 (p=0.015 and p=0.045, respectively).
- These findings indicate placental lesions correlate with specific neurodevelopmental risks.
Conclusions:
- AIUI is associated with absent FM, suggesting an increased risk for cerebral palsy (CP) in preterm infants.
- FVM and MVM predict a MOS-R < 23, indicating elevated risk for adverse non-CP neurodevelopmental outcomes.
- Impaired neurodevelopment in preterm infants may originate prenatally, highlighting the importance of placental pathology in predicting outcomes.
Background:
Preterm infants are at risk for neurodevelopmental disabilities later in life, like motor delays and cerebral palsy (CP). The placenta plays a critical role throughout pregnancy, particularly in preterm birth. Our aim is to explore the relation between placental lesions and accurate predictors of neurodevelopmental outcomes in preterm infants.
Methods:
Preterm infants (<30 weeks and/or birthweight <1000 g) were included with histopathological examination (according to Amsterdam criteria) of the placentas. We predicted the risk for future possible neurodevelopmental impairment using Prechtl's General Movement Assessment to evaluate fidgety movements (FM) at 3 months post-term. We also calculated the Motor Optimality Score-Revised (MOS-R).
Results:
In total 78 infants were included. The gestational age ranged from 24.1 to 32.6 weeks and birth weight was between 550 and 1950 g. The presence of AIUI (ascending intrauterine infection) was significantly associated with absent FMs (p = 0.034). Both the presence of fetal and maternal vascular malperfusion (FVM and MVM) were associated with a MOS-R < 23[OR4.58, 95% CI[1.35, 15.55], p = 0.015;OR2.55, 95% CI[1.02, 6.64], p = 0.045).
Conclusion:
AIUI is associated with a higher risk of absent FMs and therefore an increased risk for CP. FVM and MVM are significantly associated with MOS-R < 23, which is predictive of an elevated risk for adverse neurodevelopmental (non-CP) outcomes. This finding supports the hypothesis that impaired neurodevelopment in preterm infants already starts before birth.
Impact:
Our article underscores a key message: neurodevelopmental challenges in preterm infants originate prenatally. Our research has identified a significant association between certain placental lesions and a lower quality of fidgety movements, placing these preterm born infants at a high risk for adverse neurodevelopmental outcomes. To our knowledge, this is the first study to investigate the role of placental pathologies and risk of neurodevelopmental outcomes, while using general movements during the fidgety period. We advocate for neonatologists to integrate placental pathology assessments into their treatment strategies for newborns, recognizing its importance in enhancing care outcomes.
