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Am J Perinatol
DOI: 10.1055/a-2347-4135
Review Article

Placenta and Intestinal Injury in Preterm Infants

Padma Garg
1   Department of Pediatric Critical Care, University of Mississippi Medical Center, Jackson, Mississippi
,
Jörn-Hendrik Weitkamp
2   Department of Pediatrics/Neonatology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
,
Anna G. McDonald
3   Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Sarah N. Cilvik
4   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Imran Mir 
5   Department of Pediatrics/Neonatology, UT Southwestern Medical Center, Dallas, Texas
,
Jeffrey S. Shenberger
6   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut
,
Oluwabunmi Olaloye
7   Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
,
Liza Konnikova 
7   Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
8   Human and Translational Immunology Program, Department of Immunobiology, Department of Obstetrics Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
,
Suhas G. Kallapur
9   Department of Pediatrics/Neonatology, UCLA Mattel Children's Hospital, Los Angeles, California
,
Parvesh M. Garg
4   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina
› Author Affiliations Funding P.M.G. is partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 5U54GM115428. S.N.C. is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number 1R01HL164434.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal conditions affecting 6 to 10% of low-birth-weight infants and remains a leading cause of death. The risk factors associated with NEC are complex and multifactorial, including preterm birth and intrauterine exposure to inflammation and hypoxia. Chorioamnionitis has been associated with intestinal injury in animal and human clinical studies. This review presents current evidence about the clinical impact of the intrauterine environment on intestinal injury during pregnancy and postpregnancy. We present information from our own clinical and laboratory research in conjunction with information collected from an extensive search in the databases PubMed, EMBASE, and Scopus. Prospective multicenter studies, including accurate and precise clinical, maternal, and laboratory predictors (e.g., inflammatory biomarkers), will help identify the mechanisms associated with the placental pathology, the development of NEC, and the impact of in utero-triggered inflammation on the clinical outcomes. Filling the knowledge gap to link the inflammatory surge to postnatal life will aid in identifying at-risk infants for NEC in a timely manner and facilitate the development of novel immunomodulatory treatments or interventions to improve the outcomes of these vulnerable infants.

Key Points

  • Placental inflammatory and vascular lesions are associated with NEC severity.

  • Higher grade chorioamnionitis with a fetal response is associated with an increased risk of surgical NEC.

  • There is a need for routine bedside utilization of placenta pathology in clinical decision-making.

Keywords

placenta - chorioamnionitis - NEC - intestinal injury - preterm infant

Authors' Contributions

P.M.G., A.G.M., P.G., S.N.C., J-H.W., J.S.S., I.M., and S.G.K. wrote the article. All the authors approved the manuscript.




Publication History

Received: 02 May 2024

Accepted: 13 June 2024

Accepted Manuscript online:
18 June 2024

Article published online:
11 July 2024

© 2024. Thieme. All rights reserved.

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