Research
Obstetrics
Placental pathology in asphyxiated newborns meeting the criteria for therapeutic hypothermia

https://doi.org/10.1016/j.ajog.2010.08.024Get rights and content

Objective

We sought to describe placental findings in asphyxiated term newborns meeting therapeutic hypothermia criteria and to assess whether histopathologic correlation exists between these placental lesions and the severity of later brain injury.

Study Design

We conducted a prospective cohort study of the placentas of asphyxiated newborns, in whom later brain injury was defined by magnetic resonance imaging.

Results

A total of 23 newborns were enrolled. Eighty-seven percent of their placentas had an abnormality on the fetal side of the placenta, including umbilical cord lesions (39%), chorioamnionitis (35%) with fetal vasculitis (22%), chorionic plate meconium (30%), and fetal thrombotic vasculopathy (26%). A total of 48% displayed placental growth restriction. Chorioamnionitis with fetal vasculitis and chorionic plate meconium were significantly associated with brain injury (P = .03). Placental growth restriction appears to significantly offer protection against the development of these injuries (P = .03).

Conclusion

Therapeutic hypothermia may not be effective in asphyxiated newborns whose placentas show evidence of chorioamnionitis with fetal vasculitis and chorionic plate meconium.

Section snippets

Materials and Methods

We conducted a prospective cohort study of the placentas of term newborns with hypoxic-ischemic encephalopathy admitted to the neonatal intensive care unit who met the criteria for induced hypothermia5, 6, 8, 9: (1) gestational age ≥36 weeks and birthweight ≥2000 g; (2) evidence of fetal distress, eg, history of acute perinatal event, biophysical profile <6/10 (or 4/8) within 6 hours of birth, cord pH ≤7.0 or base deficit ≥16 mEq/L; (3) evidence of neonatal distress, such as Apgar score ≤5 at

Results

A total of 23 term neonates with perinatally acquired hypoxic-ischemic encephalopathy met the criteria for hypothermia treatment and were enrolled in the study (Table 1). Among these 23 newborns, 7 developed significant MRI evidence of hypoxic-ischemic injury involving basal ganglia in 86% (6/7) of these newborns and cortical gray matter and white matter in 57% (6/7) of these newborns (Table 2); and 16 did not (Table 2). In addition, 1 newborn had a component of intracranial hemorrhage, 2 had

Comment

It remains currently unclear why there is not a more direct correlation between degree of perinatal hypoxic-ischemic exposure and development of brain injury. In this study of term asphyxiated newborns meeting criteria for hypothermia treatment, we found that the majority of the placentas had an abnormality on the fetal side. This incidence is markedly elevated compared to a general population of all consecutive placentas from liveborn term newborns.17 This suggests that antenatal processes in

Acknowledgments

We thank the families and their newborns in participating in the study, as well as Michele DeGrazia for her thorough review of the manuscript. Special thanks are also expressed to the Critical Care Transport Team, who have brought along with the newborns several of these placentas.

References (35)

Cited by (117)

  • Placental pathology as a marker of brain injury in infants with hypoxic ischemic encephalopathy

    2022, Early Human Development
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    Although it exists for the duration of pregnancy, the placenta is a dynamic organ and its effect on the fetus, including the brain can last an entire life span [12]. The placenta is a reflection of the fetal intrauterine environment and may reveal underlying processes that directly affect brain injury [13]. Along with neuroimaging, EEG and near infrared spectroscopy, histopathological examination of the placenta is considered a neurodiagnostic technique by some investigators [14].

  • Placental Findings in Infants with Hypoxic-Ischemic Encephalopathy: The Importance of the Comparison Group

    2022, Journal of Pediatrics
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    Calculation of an OR for comparison with the repeat cesarean delivery group was not possible owing to the absence of this finding. FVM has been associated with HIE in other reports.7,9,23,25 In a case-control study of placentas from infants with and without encephalopathy, global FVM was more frequent in cases compared with controls (20% vs 7%).25

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Dr Wintermark receives research grant funding from the Thrasher Research Fund Early Career Award Program and the William Randolph Hearst Fund Award.

Cite this article as: Wintermark P, Boyd T, Gregas MC, et al. Placental pathology in asphyxiated newborns meeting the criteria for therapeutic hypothermia. Am J Obstet Gynecol 2010;203:579.e1-9.

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