Clinical and diagnostic features in the study of the condition of the placentas of extremely premature newborns and disabling pathology at preschool age

Introduction
Premature newborns are a special category of children with inherent morpho-functional immaturity and specific pathological conditions that cause significant differences in the survival and morbidity, and the consequences of their care in comparison with children of other weight categories. The problems of premature babies are at the forefront of neonatal research and perinatal care.

Aim of the research
To establish an association between the formation of adverse consequences in preschool children born prematurely, with a body weight of less than 1500 g, and placental changes.

Material and methods
The study involved 220 preschool children born prematurely. The results of a pathomorphological study of the placentas of mothers of 220 children were analysed. The results distinguished 5 groups of mothers according to the classification of changes in the placenta. In the course of the study, this category of children was under observation of the doctors of the Prematurity and Hight-risk Neonate Post-discharge Follow-up Department, in order to regular assess their health. Clinical indicators such as body weight, height, head circumference, neurological and general cognitive development, and low-severity dysfunction, the post-discharge history including respiratory diseases, skeletal system problems, and haematological and metabolic disorders was analysed. Ophthalmological and audiological examinations were performed prospectively to assess vision and hearing. Patients were divided into 3 groups depending on the severity of the disabling pathology.

Results
An analysis of the clinical parameters of children with severe disability consequences was carried out; these were divided into 5 groups according to the changes found in their placentas. All the children involved in the study had a disease combination in the neonatal period that caused severe conditions. Pathological changes of the placenta significantly affected the course of the neonatal period. Thus, newborns with signs of inflammatory changes and immaturity were 10 times more likely to suffer generalized intrauterine infections and neonatal sepsis; they also significantly more frequently had intraventricular haemorrhages, periventricular leukomalacia, and bronchopulmonary dysplasia. The course of the neonatal period in groups of children with signs of premature aging of placenta and blood flow disorders was characterized by a low frequency of infections, but periventricular leukomalacia was diagnosed 5 times more often.

Conclusions
It was found that transplacental infection and pathological placenta immaturity had a negative impact on the health of children of groups III and IV, causing their birth 3 weeks prematurely, unlike the children in the comparison group. Newborns of groups III and IV needed resuscitation care in the delivery room 9 times more often, and the need for respiratory support was 10 times higher than in the comparison group, which predetermined a significantly longer duration of hospital stay for children of groups III and IV ‒ on average 30–45 days longer compared to the newborns of group V.