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To determine the association of placental pathology with the severity of necrotizing enterocolitis (NEC) in preterm infants. This single-center matched case-control study included infants with NEC ( n  = 107) and gestational age and birth weight-matched controls ( n  = 130), born between 2013 and 2020. Placentas were evaluated according to the Amsterdam Placental Workshop Group Consensus Statement. Acute histologic chorioamnionitis with the fetal response was significantly more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%;  p  = 0.02). On regression model, infants with multiple placental pathologies (OR 2.16; 95% CI 1.01 − 4.73;  p  = 0.04) and maternal vascular malperfusion (OR 2.2; 95% CI 1.12 − 4.51;  p  = 0.02) had higher odds of either medical or surgical NEC than controls. Infants with multiple placental lesions, including placental inflammatory and vascular lesions, were at higher risk of medical or surgical NEC in the postnatal period.

Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants – A Matched Case-Control Study