Postnatal corticosteroid treatment more effective in neonates born to mothers with placental injury

Netherland: A recent study published in the European Journal of Pediatrics has concluded that Neonates born after maternal vascular malperfusion (placental injury) show a better response to postnatal corticosteroid treatment.

Preterm infants <29 weeks gestational age are at high risk for death and disability. Bronchopulmonary dysplasia (BPD), a common chronic respiratory morbidity in surviving preterm infants, has an incidence of ~45%. The risk factors for BPD include intrauterine growth restriction, lack of antenatal steroids, chorioamnionitis, prolongation of mechanical ventilation, supplemental oxygen, and sepsis.

Children with BPD suffer from cardiopulmonary impairments, growth failure, hearing and vision deficits, delayed neurodevelopment, post-neonatal mortality, cerebral palsy, abnormalities in cognition, etc.

There is conflicting evidence of an association between placental pathology and neonatal outcomes. The studies have mentioned the association between placental pathology (single) and neonatal outcomes like acute histologic chorioamnionitis (AHC) and BPD, maternal vascular under perfusion (MVU) and BPD, etc.

Postnatal corticosteroids are given to preterm neonates for the prevention of bronchopulmonary dysplasia. Non-responders are those neonates who do not respond to corticosteroids.

Considering this, a study led by V. M. Koenders from the Isala Hospital Neonatal Intensive Care Unit to investigate "What is the association between placental pathology and short-term response to corticosteroids in neonates < 32 weeks postconceptional age at risk for bronchopulmonary dysplasia?"

The critical points of the study are:

• The study included neonates < 32 weeks who were born between 2009 – 2016 and were on corticosteroid therapy during BPD.

• Based on the placental histology, the preterm neonates were divided into three groups.

• The three groups were acute chorioamnionitis, maternal vascular malperfusion, and no placental pathology.

• The respiratory support assessment was done before treatment and on day four and day 7.

• After starting corticosteroid treatment, the responder was determined by extubation within seven days.

• The total responders in the chorioamnionitis neonates, maternal vascular malperfusion neonates, and no pathology were 52%, 67%, and 58%.

• On days 4 and 7, extubation had odds ratios of 0.53 and 0.66 in the chorioamnionitis group compared to the maternal vascular malperfusion.

The co-researcher, A. Appels from the Isala Hospital at Neonatal Intensive Care Unit, wrote there was no significant difference in Short-term response to postnatal corticosteroids between premature neonates born after acute chorioamnionitis, maternal vascular malperfusion, or no placenta pathology.

The researchers added a better trend of corticosteroid response is found in maternal vascular malperfusion neonates. This may be due to differences in prenatal pulmonary development and postnatal cortisol.

The team explained BD is related to chorioamnionitis and maternal vascular malperfusion. Corticosteroids are the primary treatment modality. Some preterm neonates respond to it, while some do not (non-responders). This non-responsiveness is related to the difference in pulmonary inflammation and systemic cortisol. Triggered predispositions further explain this due to chorioamnionitis and maternal vascular imperfusion.

Further reading:

Koenders, V.M., Appels, A., van Straaten, H.L.M. et al. Postnatal corticosteroid response in neonates < 32 weeks and relation with placental pathology. Eur J Pediatr (2022). https://doi.org/10.1007/s00431-022-04672-9