Imran N Mir1, Sarah F Johnson-Welch2, David B Nelson3, Larry S Brown4, Charles R Rosenfeld1, Lina F Chalak5. 1. Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. 2. Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. 3. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. 4. Department of Health System Research, Parkland Hospital at Dallas, Dallas, TX. 5. Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. Electronic address: lina.chalak@utsouthwestern.edu.
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.
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.
Authors: C M C Frank; P G J Nikkels; J C Harteman; I C van Haastert; M J N L Benders; C Koopman-Esseboom; L S de Vries; F Groenendaal Journal: J Perinatol Date: 2016-08-18 Impact factor: 2.521
Authors: Daniel Mota-Rojas; Dina Villanueva-García; Alfonso Solimano; Ramon Muns; Daniel Ibarra-Ríos; Andrea Mota-Reyes Journal: Biomedicines Date: 2022-02-01
Authors: Jessica L Wisnowski; Stefan Bluml; Ashok Panigrahy; Amit M Mathur; Jeffrey Berman; Ping-Sun Keven Chen; James Dix; Trevor Flynn; Stanley Fricke; Seth D Friedman; Hayden W Head; Chang Y Ho; Beth Kline-Fath; Michael Oveson; Richard Patterson; Sumit Pruthi; Nancy Rollins; Yanerys M Ramos; John Rampton; Jerome Rusin; Dennis W Shaw; Mark Smith; Jean Tkach; Shreyas Vasanawala; Arastoo Vossough; Matthew T Whitehead; Duan Xu; Kristen Yeom; Bryan Comstock; Patrick J Heagerty; Sandra E Juul; Yvonne W Wu; Robert C McKinstry Journal: BMJ Open Date: 2021-04-22 Impact factor: 2.692