Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia Presented in poster format at the annual meeting of the Pediatric Academic Societies, Vancouver, British Columbia, Canada, May 3-6, 2014.

Imran N. Mir, Sarah F. Johnson-Welch, David B. Nelson, Larry S. Brown, Charles R. Rosenfeld, Lina F. Chalak

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Objective Although neonatal encephalopathy (NE) due to perinatal asphyxia accounts for a notable proportion of brain injury, the causal pathway remains largely unexplained. We sought to determine the association of placental pathology with: (1) severity of NE in the first 6 hours postnatal, and (2) abnormal neurodevelopmental outcomes (NDO) in neonates requiring hypothermia therapy. Study Design This is a retrospective cohort study of neonates ≥36 weeks' gestation born at Parkland Hospital, Dallas, TX, from January 2006 through November 2011 with NE. Placental histology was reviewed and validated by a pediatric pathologist blinded to outcomes. Abnormal NDO was defined as death or Bayley-III score of <85 at 18-24 months of age. Results Of 86,274 neonates ≥36 weeks' gestation, 120 had evidence of a combination of perinatal acidosis and NE. In all, 47 had mild NE and received no treatment, while 73 had moderate (n = 70) or severe (n = 3) NE and received systemic hypothermia. Nine neonates died and all survivors receiving hypothermia had a Bayley-III assessment at 22 ± 7 (SD) months of age. Chorioamnionitis with or without fetal response and patchy/diffuse chronic villitis were found to be independently associated with severity of NE (P <.001). Univariate logistic regression revealed an association with a diagnosis of major placental pathology (odds ratio, 3.5; 95% confidence interval, 1.1-11.4) and abnormal outcomes following cooling. Specifically, diffuse chronic villitis (odds ratio, 9.29; 95% confidence interval, 1.11-77.73) was the only individual predictor of abnormal NDO following hypothermia therapy. Conclusion Placental inflammatory villitis appears to be a harbinger of abnormal outcomes in neonates with NE, spanning to the 18-24 month NDO.

Original languageEnglish (US)
Pages (from-to)849.e1-849.e7
JournalAmerican journal of obstetrics and gynecology
Volume213
Issue number6
DOIs
StatePublished - 2015

Keywords

  • hypothermia
  • hypoxic ischemic encephalopathy
  • neonatal encephalopathy
  • neurodevelopmental outcome

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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