American Journal of Obstetrics and Gynecology
ResearchObstetricsPlacental pathology in asphyxiated newborns meeting the criteria for therapeutic hypothermia
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.
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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.