Placenta and Intestinal Injury in Preterm Infants

Padma Garg; Jörn-Hendrik Weitkamp; Anna G. McDonald; Sarah N. Cilvik; Imran Mir; Jeffrey S. Shenberger; Oluwabunmi Olaloye; Liza Konnikova; Suhas G. Kallapur; Parvesh M. Garg

doi:10.1055/a-2347-4135

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(04): 415-419
DOI: 10.1055/a-2347-4135

Review Article

Placenta and Intestinal Injury in Preterm Infants

Padma Garg

¹Department of Pediatric Critical Care, University of Mississippi Medical Center, Jackson, Mississippi

,

Jörn-Hendrik Weitkamp

²Department of Pediatrics/Neonatology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee

,

Anna G. McDonald

³Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina

,

Sarah N. Cilvik

⁴Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina

,

Imran Mir

⁵Department of Pediatrics/Neonatology, UT Southwestern Medical Center, Dallas, Texas

,

Jeffrey S. Shenberger

⁶Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut

,

Oluwabunmi Olaloye

⁷Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut

,

Liza Konnikova

⁷Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut

⁸Human and Translational Immunology Program, Department of Immunobiology, Department of Obstetrics Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut

,

Suhas G. Kallapur

⁹Department of Pediatrics/Neonatology, UCLA Mattel Children's Hospital, Los Angeles, California

,

Parvesh M. Garg

⁴Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina

› Author Affiliations

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

Full Text

References

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