Placental lesions associated with neurologic impairment and cerebral palsyin very low-birth-weight infants

Objective.-Systematic placental examination has the potential to shed light on poorly understood antenatal processes that may increase the risk of neu rologic impairment and cerebral palsy. Design.-Using data from a retrospective case-control study, we analyzed pla centas from 60 inborn, singleton, very low-birth-weight (<1.5 kg) infants d elivered between 1983 and 1991 who had subsequent neurologic impairment at 20 months corrected age (42 with cerebral palsy and 18 with other neurologi c abnormalities) and 59 control infants of comparable gestational age, birt h weight, sex, and race. Three a priori hypotheses based on previous studie s were that neurologic impairment would be increased with fetal vascular le sions with or without coexisting chorioamnionitis, decreased with chronic m aternal vascular underperfusion, and increased when multiple placental abno rmalities were seen in the same case. Results and Conclusions.-We found 2 types of fetal placental vascular lesio ns to be associated with neurologic impairment, namely, recent nonocclusive thrombi of chorionic plate vessels (P < .04) and severe villous edema (P < .01). Chorionic plate thrombi were seen only with chorioamnionitis and acc ounted for the increased risk of neurologic impairment seen with chorioamni onitis. Maternal vascular lesions showed a biphasic relation to neurologic impairment in the subgroup of patients without chorioamnionitis. Mild lesio ns were increased in controls (inadequate vascular remodeling, P = .03, and accelerated maturation, P = .004). A more severe lesion, multiple villous infarcts, although not reaching significance, was increased in the neurolog ically impaired cases. Finally, in a test of 9 selected placental lesions, cases with cerebral palsy were more likely to have 2 or more lesions (P < . 0001) and were less likely to have no lesions (P < .04) than control infant s.