Leveraging the placenta to advance neonatal care

Abstract

The impact of placental dysfunction and placental injury on the fetus and newborn infant has become a topic of growing interest in neonatal disease research. However, the use of placental pathology in directing or influencing neonatal clinical management continues to be limited for a wide range of reasons, some of which are historical and thus easily overcome today. In this review, we summarize the most recent literature linking placental function to neonatal outcomes, focusing on clinical placental pathology findings and the most common neonatal diagnoses that have been associated with placental dysfunction. We discuss how recent technological advances in neonatal and perinatal medicine may allow us to make a paradigm shift, in which valuable information provided by the placenta could be used to guide neonatal management more effectively, and to ultimately enhance neonatal care in order to improve our patient outcomes. We propose new avenues of clinical management in which the placenta could serve as a diagnostic tool toward more personalized neonatal intensive care unit management.

Keywords: bronchopulmonary dysplasia (BPD); chorioamnionitis; neonatal intensive care unit (NICU); neonatal outcome; placental pathology; preeclampsia; prematurity and low birth weight.

Figure 1

Four major histologic domains of the standard placental pathology exam. AI, acute inflammation; CI, chronic inflammation; MVM, maternal vascular malperfusion; FVP, fetal vascular pathology (also referred to as fetal vascular malperfusion or FVM). Histology images provided by Northwestern University Feinberg School of Medicine, Department of Pathology.

Figure 2

Placental pathways of lung disease: proposed schematic of how detailed review of placental histology along the different pathologic domains can guide NICU management of multifactorial diseases such as BPD. NICU, neonatal intensive care unit; BPD, bronchopulmonary dysplasia.

Figure 3

Overview of the potential role of the placenta in NICU management of preterm and low birth weight infants. BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis; NICU, neonatal intensive care unit; PDA, patent ductus arteriosus; ROP, retinopathy of prematurity.

Figure 4

Cord blood biomarkers associated with the four domains of placental histology. Findings adapted from Mestan et al. in which 15 analytes were measured in cord blood plasma using Luminex multiplex immunoassay across four placental histologic domains. G-CSF, granulocyte colony-stimulating factor; IL, interleukin; VEGF, vascular endothelial growth factor; PLGF, placental growth factor; FGF, fibroblast growth factor (11).