Placental Histology and Response To Postnatal Corticosteroid Treatment: A Retrospective Cohort Study

Background: The placenta fulfills a key function during prenatal development, however, a malfunctioning placenta can impede neonatal development. Well-known examples of placental pathology are maternal vascular underperfusion (MVU) and chorioamnionitis (CA), both triggering preterm birth. The most common chronic disease in preterm infants is bronchopulmonary dysplasia (BPD), partially explained by the difference between intra-uterine and postnatal lung development. BPD is treated with corticosteroids (hydrocortisone and/or dexamethasone). Unfortunately, not all neonates respond to corticosteroids, the so-called non-responders. Non-responders remain intubated and oxygen dependent. Interestingly, recent studies suggest an association between placental pathology and postnatal response to corticosteroids.

Objective: Determine the association between placental pathology and short-term response to postnatal corticosteroids in neonates

Methods: A retrospective study including all neonates receiving hydrocortisone and/or dexamethasone in the course of BPD between 2009 and 2016 at the Isala hospital Zwolle. The definition of responder was extubation within 7 days of corticosteroid treatment.

Preliminary results: 71 neonates with a mean gestational age of 25.8 (SD 1.19) weeks and birth weight of 825 grams (SD 195) were included. As depicted in figure 1, 24 (34%) neonates were born after CA, 34 (48%) neonates after MVU and 13 (18%) preterm births could not be explained by placental histology. 52% of the CA neonates and 67% of the MVU neonates were responders.

Conclusion: A trend of better short-term postnatal corticosteroid response in MVU neonates was found, probably due to the time of onset of inflammation. MVU is associated with postnatal onset while CA results in antenatal inflammation.