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.
Key words
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Article Info
Publication History
Published online: September 22, 2015
Footnotes
L.F.C. is supported by National Institutes of Health grant K23-HD069521 and a Gerber Foundation grant.
The authors report no conflict of interest.
Cite this article as: Mir IN, Johnson-Welch SF, Nelson DB, et al. Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia. Am J Obstet Gynecol 2015;213:849.e1-7.
Identification
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
