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Arch Dis Child Fetal Neonatal Ed 98:F158-F160 doi:10.1136/archdischild-2011-301505
  • Short research report

Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy

  1. Anne Twomey1
  1. 1Department of Neonatology, National Maternity Hospital, Dublin, Ireland
  2. 2Department of Radiology, National Maternity Hospital, Dublin, Ireland
  3. 3Department of Radiology, Children's University Hospital, Dublin, Ireland
  4. 4Department of Pathology, National Maternity Hospital, Dublin, Ireland
  5. 5Department of Psychology, National Maternity Hospital, Dublin, Ireland
  1. Correspondence to Dr Michael Joseph Barrett, Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Ireland; mjjbarrett{at}hotmail.com
  • Received 7 December 2011
  • Revised 5 June 2012
  • Accepted 18 June 2012
  • Published Online First 19 July 2012

Abstract

We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.

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