We read with much interest the paper by Redline
and colleagues [1] about placental lesions as
predictors of neuromotor and cognitive outcome
at school age in extremely low–birth weight infants
(ELBWI). They found that lesions associated with
maternal underperfusion were most closely linked
with cerebral palsy, while those involving the fetal
vasculature, villous edema, and severe-grade 3/3
fetal inflammation were more closely related to
abnormal results in neurocognitive tests measuring
global cognitive ability and executive functioning
at school age.
The reason why maternal vascular lesions
should be more strongly linked to motor function
and fetal vascular lesions to neurocognitive
abnormalities has not yet been clarified; however,
the correlations between histological chorioamnionitis
(HCA) and adverse neurodevelopmental
outcome of ELBWI are currently a major focus
of research [1–3]. We are studying the relationship
between preterm HCA, graded and scored according
to the method of Redline and colleagues [1],
and neuromotor and neurocognitive development
in a cohort of 102 premature neonates (,32 weeks
of gestation) admitted to the level III neonatal
intensive care unit of the Department of Pediatrics
of Padua University (Padua, Italy) between January
1998 and December 2002. We found that the
preschool age intelligence quotient, measured by
the Wechsler Preschool and Primary Scale of
Intelligence, and neuropsychological functions
were not statistically different in HCA and non-
HCA groups. Instead, executive functions, Tower
of London, and Elithorn Perceptual Maze Test werebelow 2 standard deviations in 16% of HCAversus
5% of non-HCA subjects.
Unlike Redline and colleagues, we did not
separate infant subgroups with distinct HCA
pathologic characteristics as predictors of abnormal
cognitive and/or executive functions. However, our
data indicate that premature infants with HCA have
high rates of neurodisability at preschool age,
which indicates the need to investigate LBWI
subgroups with distinct pathological and perinatal
characteristics and to extend the follow-up at
school age
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