Yvonne W Wu1,2, Amy M Goodman3, Taeun Chang4,5,6, Sarah B Mulkey4,5,6, Fernando F Gonzalez7, Dennis E Mayock8, Sandra E Juul8, Amit M Mathur9, Krisa Van Meurs10, Robert C McKinstry11, Raymond W Redline12. 1. Department of Neurology, University of California San Francisco, San Francisco, CA, USA. WuY@ucsf.edu. 2. Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. WuY@ucsf.edu. 3. Department of Neurology, University of California San Francisco, San Francisco, CA, USA. 4. Department of Neurology, Children's National Health Systems, Washington, DC, USA. 5. Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. 6. Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. 7. Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. 8. Department of Pediatrics, University of Washington, Seattle, WA, USA. 9. Departments of Pediatrics, Washington University, St. Louis, MO, USA. 10. Department of Pediatrics, Stanford University, Palo Alto, CA, USA. 11. Department of Radiology, Washington University, St. Louis, MO, USA. 12. Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Abstract
BACKGROUND:Newborns with hypoxic-ischemic encephalopathy (HIE) may exhibit abnormalities on placental histology. In this phase II clinical trial ancillary study, we hypothesized that placental abnormalities correlate with MRI brain injury and with response to treatment. METHODS:Fifty newborns with moderate/severe encephalopathy who received hypothermia were enrolled in a double-blind, placebo-controlled trial of erythropoietin for HIE. A study pathologist reviewed all available clinical pathology reports to determine the presence of chronic abnormalities and acute chorioamnionitis. Neonatal brain MRIs were scored using a validated HIE scoring system. RESULTS:Placental abnormalities in 19 of the 35 (54%) patients with available pathology reports included chronic changes (N = 13), acute chorioamnionitis (N = 9), or both (N = 3). MRI subcortical brain injury was less common in infants with a placental abnormality (26 vs. 69%, P = 0.02). Erythropoietin treatment was associated with a lower global brain injury score (median 2.0 vs. 11.5, P = 0.003) and lower rate of subcortical brain injury (33 vs. 90%, P = 0.01) among patients with no chronic placental abnormality but not in patients whose placentas harbored a chronic abnormality. CONCLUSION:Erythropoietin treatment was associated with less brain injury only in patients whose placentas exhibited no chronic histologic changes. Placentas may provide clues to treatment response in HIE.
RCT Entities:
BACKGROUND: Newborns with hypoxic-ischemicencephalopathy (HIE) may exhibit abnormalities on placental histology. In this phase II clinical trial ancillary study, we hypothesized that placental abnormalities correlate with MRI brain injury and with response to treatment. METHODS: Fifty newborns with moderate/severe encephalopathy who received hypothermia were enrolled in a double-blind, placebo-controlled trial of erythropoietin for HIE. A study pathologist reviewed all available clinical pathology reports to determine the presence of chronic abnormalities and acute chorioamnionitis. Neonatal brain MRIs were scored using a validated HIE scoring system. RESULTS: Placental abnormalities in 19 of the 35 (54%) patients with available pathology reports included chronic changes (N = 13), acute chorioamnionitis (N = 9), or both (N = 3). MRI subcortical brain injury was less common in infants with a placental abnormality (26 vs. 69%, P = 0.02). Erythropoietin treatment was associated with a lower global brain injury score (median 2.0 vs. 11.5, P = 0.003) and lower rate of subcortical brain injury (33 vs. 90%, P = 0.01) among patients with no chronic placental abnormality but not in patients whose placentas harbored a chronic abnormality. CONCLUSION:Erythropoietin treatment was associated with less brain injury only in patients whose placentas exhibited no chronic histologic changes. Placentas may provide clues to treatment response in HIE.
Authors: Jennifer K Lee; Polan T Santos; May W Chen; Caitlin E O'Brien; Ewa Kulikowicz; Shawn Adams; Henry Hardart; Raymond C Koehler; Lee J Martin Journal: J Neuropathol Exp Neurol Date: 2021-01-20 Impact factor: 3.685
Authors: C Zenobi; J L Wisnowski; B Tamrazi; A M-C Wong; R Chapman; S Blüml; T-W Wu Journal: AJNR Am J Neuroradiol Date: 2022-02-03 Impact factor: 3.825