Periventricular Leukomalacia in a Preterm Cohort: Associations With Placental Pathology

Abstract

Introduction:

Preterm infants are at risk for white matter brain injury characterized by periventricular leukomalacia (PVL) with exposure to in-utero inflammation. Our aim was to correlate placental pathology with PVL in a cohort of preterm infants.

Methods:

All infants born <1500 g between Jan 1, 2017 and July 31, 2022 with placental pathology reports and neonatal outcome data on PVL were included in this study. Placental pathology findings were divided into 4 major categories (acute inflammation (AI), chronic inflammation (CI), fetal vascular malperfusion (FVM), and maternal vascular malperfusion (MVM)); each category was graded as absent, low-grade, or high-grade.

Results:

We identified 263 infants with data for PVL and placental pathology. Gestational age (GA) averaged 28 completed weeks and mean birthweight was 1050 g. 11/263 (4.2%) infants had PVL. Acute inflammation was seen in 9/11 (82%) infants with PVL and only 101/252 (40%) of those without PVL (P = .01). Eight of the nine infants with PVL and AI (89%) had high-stage AI. In analyses adjusted for gestational age, the prevalences of CI, FVM and MVM were not significantly different between infants with or without PVL.

Conclusion:

In a large cohort of preterm infants, we demonstrate a strong association between AI in the placenta (histologic chorioamnionitis) and PVL in infants born <1500 g.