Abstract
AIM: This study aims to investigate the association between placental insufficiency and complications in extremely preterm infants in the context of ischemic placental disease (IPD), including preeclampsia, small-for-gestational-age (SGA), and placental abruption. METHODS: Infants born between 22 and 28 weeks of gestation were classified into IPD and non-IPD groups, matched 1:1 by gestational age and sex. The incidence of neonatal complications was analyzed. RESULTS: Analysis included 48 infants in each group. The IPD group had a significantly lower birth weight (IPD vs. non-IPD: 679 g vs. 979 g, p < 0.001), whereas the non-IPD group was characterized by a higher prevalence of spontaneous preterm births (12% vs. 79%, p < 0.001) and a significantly higher incidence of histological chorioamnionitis (CAM) (15% vs. 50%, p < 0.001). The IPD group showed a significantly higher incidence of bronchopulmonary dysplasia (BPD) compared to the non-IPD group (85% vs. 48%, p < 0.001), with no significant differences in other complications such as intraventricular hemorrhage, retinopathy of prematurity, and necrotizing enterocolitis. Logistic regression identified IPD as a significant risk factor for BPD (odds ratio [OR] [95% confidence interval]: 9.4 [2.8-31.8], p < 0.001), along with preeclampsia (OR: 4.9 [1.3-18.3], p = 0.01) and SGA (OR: 31.9 [5.9-171], p < 0.001). CAM was not associated with BPD (OR: 0.6 [0.2-1.7], p = 0.45). CONCLUSIONS: Placental insufficiency, manifesting as IPD, is strongly associated with an increased risk of BPD in extremely preterm infants.