Relationship between the severity of respiratory and cardiovascular disorders in preterm infants and the degree and size of maternal abnormal placentation

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Abstract

Objective: To assess the severity of respiratory and cardiovascular disorders in preterm infants based on the degree and anatomical and topographic type of placenta accreta spectrum disorders as well as the diameter of the placental hernia in their mothers.

Materials and methods: A retrospective cohort study was conducted involving 288 preterm infants with a gestational age (GA) of 330–366 weeks born to mothers with placenta accreta spectrum disorders. The clinical data were analyzed in three stages. In Stage I, patients were divided into three groups based on the type of placenta accreta spectrum (accreta, increta, and percreta). In Stage II, infants were classified into five groups according to the anatomical and topographic types of the placenta accreta spectrum, following H. Palacius's classification. In Stage III, the infants were divided into two groups based on the placental hernia diameter. In the study groups, GA, anthropometric parameters, sex, Apgar scores at 1 and 5 min after birth, and the correspondence of body weight and length to GA were compared. The severity and duration of respiratory disorders were assessed using indirect criteria: frequency and duration of respiratory therapy, including mechanical ventilation (MV) and high-frequency oscillatory ventilation (HFOV), maximum required mean airway pressure (MAP), frequency and duration of additional oxygen supplementation, and frequency of surfactant replacement therapy. The severity of acute cardiovascular disorders was evaluated based on the frequency of cardiotonic and vasopressor therapies, including the use of dopamine and dobutamine, and the maximum vasoactive inotropic index (VII). Integral indicators of the severity of preterm infants' conditions after birth included the length of stay in the NICU and total duration of hospitalization in days.

Results: The analysis revealed no significant differences in the severity of respiratory and cardiovascular disorders among newborns based on the degree of placental invasion or type of accreta. However, a significant increase in hospitalization duration was observed in newborns of mothers with placenta percreta compared to those born to mothers with placenta accreta, likely due to the lower GA of infants born to mothers with placenta percreta. Additionally, an increase in the duration of HFOV and the need for higher HFOV parameters, particularly MAP, were noted in preterm infants born to mothers with a placental hernia diameter exceeding 7 cm.

Conclusion: The severity of respiratory and cardiovascular disorders in preterm infants was not influenced by the degree of abnormal placental invasion or the anatomical and topographic type of placental implantation. However, a correlation was found between the severity of respiratory disorders and the placental hernia diameter.

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About the authors

Anastasia D. Balakina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: nikon.na@yandex.ru
ORCID iD: 0000-0002-4717-1865

anesthesiologist-resuscitator of the NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics

Russian Federation, 117997, Moscow, Oparin str., 4 Moscow

Ekaterina N. Balashova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: e_balashova@oparina4.ru
ORCID iD: 0000-0002-3741-0770

PhD, Leading Researcher at the NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics, Associate Professor at Neonatology Department of the Faculty of Pediatrics

Russian Federation, 117997, Moscow, Oparin str., 4; 119435, Moscow, Bolshaya Pirogovskaya str, 2-4

Oleg V. Ionov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University); Research Clinical Institute of Childhood, Ministry of Health of the Moscow Region

Email: o_ionov@oparina4.ru
ORCID iD: 0000-0002-4153-133X

Dr. Med. Sci., Head of the NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics, Professor at Neonatology Department of the Faculty of Pediatrics, Chief Researcher, Research Clinical Institute of Childhood, Ministry of Health of the Moscow Region

Russian Federation, 117997, Moscow, Oparin str., 4; 119435, Moscow, Bolshaya Pirogovskaya str, 2-4; 141009, Moscow region, Mytishchi, Kominterna st., 24A/1

Anna R. Kirtbaya

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: a_kirtbaya@oparina4.ru
ORCID iD: 0000-0002-7628-8157

Dr. Med. Sci., Head of the Clinical Work, NICU named after Prof. A.G. Antonov of the Institute of Neonatology and Pediatrics, Professor at Neonatology Department of the Faculty of Pediatrics

Russian Federation, 117997, Moscow, Oparin str., 4; 119435, Moscow, Bolshaya Pirogovskaya str, 2-4

Alexandra A. Mikheeva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: shuratora@mail.ru

obstetrician-gynecologist

Russian Federation, 117997, Moscow, Oparin str., 4

Oksana N. Vasilchenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: o_vasilchenko@oparina4.ru
ORCID iD: 0000-0001-9434-0011

PhD, Senior Researcher at the Department of Innovative Technologies

Russian Federation, 117997, Moscow, Oparin str., 4

Victor V. Zubkov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: v_zubkov@oparina4.ru
ORCID iD: 0000-0001-8366-5208

Dr. Med. Sci., Professor, Director of the Institute of Neonatology and Pediatrics, Head of Neonatology Department of the Department of Professional Education

Russian Federation, 117997, Moscow, Oparin str., 4; 119435, Moscow, Bolshaya Pirogovskaya str, 2-4

Roman G. Shmakov

Academician V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: MDshmakov@mail.ru
ORCID iD: 0000-0002-2206-1002

Dr. Med. Sci., Director, Professor at the Department of Obstetrics and Gynecology, Faculty of Pediatrics, Chief Freelance Obstetrics Specialist of the Ministry of Health of the Russian Federation

Russian Federation, 101000, Moscow, Pokrovka str., 22a; 117513 Moscow, Ostrovityanova str., 1/7

Dmitriy N. Degtyarev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: d_degtiarev@oparina4.ru
ORCID iD: 0000-0001-8975-2425

Dr. Med. Sci., Professor, Deputy Director, Professor at Neonatology Department, Head of the Department of Neonatology, Institute of Children's Health

Russian Federation, 117997, Moscow, Oparin str., 4; 119435, Moscow, Bolshaya Pirogovskaya str, 2-4

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2. Fig. 1. Study design

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3. Fig. 2. Comparative data on the duration of stay of premature infants in the NICU depending on the degree of placenta accreta in the mother

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4. Fig. 3. Comparative data on the duration of hospitalization of premature newborns depending on the degree of placenta accreta in the mother

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