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.

Noninvasive Monitoring Strategies for Bronchopulmonary Dysplasia or Post-Prematurity Respiratory Disease: Current Challenges and Future Prospects

“…Chorioamnionitis status and the recognition of placental inflammatory pathways (acute and chronic inflammation) and vascular pathways (maternal and foetal vascular disease) are predictive of BPD [20]. There is growing interest in models for predicting histologic chorioamnionitis and adverse outcomes in preterm infants [21].…”

“…As a matter of fact, BPD already develops in utero, and antenatal interventions should be investigated for pregnant women with a higher risk of chorioamnionitis. Placental inflammatory and vascular pathways may also be associated with response to postnatal therapies [20].…”

Noninvasive Monitoring Strategies for Bronchopulmonary Dysplasia or Post-Prematurity Respiratory Disease: Current Challenges and Future Prospects

“…With chorioamnionitis, the placental inflammatory (acute and chronic inflammation) and vascular pathways (maternal and foetal vascular disease) are predictive of BPD [20]. There is a growing interest in developing models for predicting histologic chorioamnionitis and adverse outcomes in preterm infants [21].…”

“…As a matter of fact, BPD already develops in utero, and antenatal interventions in women with a higher risk of chorioamnionitis should be investigated. Placental inflammatory and vascular pathways may also be associated with the response to postnatal therapies [20].…”

Stem/Progenitor Cells and Related Therapy in Bronchopulmonary Dysplasia

“…Alongside a number of postnatal challenges that contribute to the development of BPD, the results of several studies have implicated that adverse conditions during pregnancy like placental vascular disease, intrauterine growth restriction, or chorioamnionitis may already be sufficient to induce or at least promote BPD and its related consequences [ 8 ].…”