Rechercher
image du produit
Journal of Pediatrics, The

S'abonner

Acute and Chronic Placental Abnormalities in a Multicenter Cohort of Newborn Infants with Hypoxic–Ischemic Encephalopathy - 22/09/21

Doi : 10.1016/j.jpeds.2021.06.023 
Lina Chalak, MD, MSCS 1, ⁎ , Raymond W. Redline, MD 2, Amy M. Goodman, PhD 3, Sandra E. Juul, MD PhD 4, Taeun Chang, MD 5, Toby D. Yanowitz, MD MS 6, Nathalie Maitre, MD PhD 7, Dennis E. Mayock, MD 4, Andrea L. Lampland, MD 8, Ellen Bendel-Stenzel, MD 9, David Riley, MD 10, Amit M. Mathur, MD 11, Rakesh Rao, MD 12, Krisa P. Van Meurs, MD 13, Tai-Wei Wu, MD 14, 15, Fernando F. Gonzalez, MD 16, John Flibotte, MD 17, 18, Ulrike Mietzsch, MD 4, 19, Gregory M. Sokol, MD 19, Kaashif A. Ahmad, MD 20, Mariana Baserga, MD 21, Joern-Hendrik Weitkamp, MD 22, Brenda B. Poindexter, MD MS 23, Bryan A. Comstock, MS 24, Yvonne W. Wu, MD MPH 3
1 Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 
2 Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH 
3 Department of Neurology, University of California San Francisco, San Francisco, CA 
4 Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 
5 Department of Neurology, Children's National Hospital, George Washington School of Medicine, Washington, DC 
6 Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC and Magee Womens Hospital of UPMC, Pittsburgh, PA 
7 Department of Pediatrics and Research Institute, Nationwide Children's Hospital, Columbus, OH 
8 Department of Neonatology, Children's Minnesota, St Paul, MN 
9 Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 
10 Department of Pediatrics, Cook Children's Medical Center, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, TX 
11 Department of Pediatrics/Neonatal-Perinatal Medicine, Saint Louis University School of Medicine, St Louis, MO 
12 Division of Newborn-Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 
13 Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA 
14 Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, CA 
15 Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 
16 Department of Pediatrics, University of California San Francisco, San Francisco, CA 
17 Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA 
18 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 
19 Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 
20 Pediatrix Medical Group of San Antonio, San Antonio, TX 
21 Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT 
22 Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 
23 Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, GA 
24 Department of Biostatistics, University of Washington, Seattle, WA 

∗Reprint requests: Lina Chalak, MD, MSCS, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063.University of Texas Southwestern Medical CenterDallasTX75390-9063

Abstract

Objective

To examine the frequency of placental abnormalities in a multicenter cohort of newborn infants with hypoxic–ischemic encephalopathy (HIE) and to determine the association between acuity of placental abnormalities and clinical characteristics of HIE.

Study design

Infants born at ≥36 weeks of gestation (n = 500) with moderate or severe HIE were enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy Trial. A placental pathologist blinded to clinical information reviewed clinical pathology reports to determine the presence of acute and chronic placental abnormalities using a standard classification system.

Results

Complete placental pathologic examination was available for 321 of 500 (64%) trial participants. Placental abnormalities were identified in 273 of 321 (85%) and were more common in infants ≥40 weeks of gestation (93% vs 81%, P = .01). A combination of acute and chronic placental abnormalities (43%) was more common than either acute (20%) or chronic (21%) abnormalities alone. Acute abnormalities included meconium staining of the placenta (41%) and histologic chorioamnionitis (39%). Chronic abnormalities included maternal vascular malperfusion (25%), villitis of unknown etiology (8%), and fetal vascular malperfusion (6%). Infants with chronic placental abnormalities exhibited a greater mean base deficit at birth (−15.9 vs −14.3, P = .049) than those without such abnormalities. Patients with HIE and acute placental lesions had older mean gestational ages (39.1 vs 38.0, P < .001) and greater rates of clinically diagnosed chorioamnionitis (25% vs 2%, P < .001) than those without acute abnormalities.

Conclusions

Combined acute and chronic placental abnormalities were common in this cohort of infants with HIE, underscoring the complex causal pathways of HIE.

Trial registration

ClinicalTrials.gov: NCT02811263

Le texte complet de cet article est disponible en PDF.

Keywords : placenta, HIE, encephalopathy, neonate

Abbreviation : HEAL, HIE


Plan


 Supported by National Institute of Neurological Disorders and Stroke (NINDS) 1U01NS092764-01. The authors declare no conflicts of interest.


© 2021  Publié par Elsevier Masson SAS.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

    •

  • Contenu

    •

Vol 237

P. 190-196 - octobre 2021 Retour au numéro
Article précédent Article précédent
  • Cerebral Palsy in Very Preterm Infants: A Nine-Year Prospective Study in a French Population-Based Tertiary Center
  • Clément Chollat, Emmanuelle Bertrand, Alice Petit-Ledo, Caroline de Vansay, Caroline Voisin, Ivana Dabaj, André Gillibert, Stéphane Marret, Perinatal Network of Upper Normandy, C. Lévêque, J.-L. Simenel, S. Pauthier, C. Levavasseur, I. Pop, N. Grancher, A. Lefebure, C. Vittecoq, D. Dabbagh, E. Machevin, M. Levy, F. Taleb, H. Lahrach, H. Rhali, B. Richet, F. Delaunay, H. Bruel, A. Selim, M. Jaffray, M. Durand-Réville, C. Sarreau, S. Celik, J.-F. Le Digabel, J. Stoller, H. Muszynski, M. Rouha, E. Verspyck, A. Chadi, C. Lardennois
| Article suivant Article suivant
  • Neonatal Cranial Ultrasound Findings among Infants Born Extremely Preterm: Associations with Neurodevelopmental Outcomes at 10 Years of Age
  • Heather Campbell, Jennifer Check, Karl C.K. Kuban, Alan Leviton, Robert M. Joseph, Jean A. Frazier, Laurie M. Douglass, Kyle Roell, Elizabeth N. Allred, Lynn Ansley Fordham, Stephen R. Hooper, Hernan Jara, Nigel Paneth, Irina Mokrova, Hongyu Ru, Hudson P. Santos, Rebecca C. Fry, T. Michael O’Shea

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Elsevier s'engage à rendre ses eBooks accessibles et à se conformer aux lois applicables. Compte tenu de notre vaste bibliothèque de titres, il existe des cas où rendre un livre électronique entièrement accessible présente des défis uniques et l'inclusion de fonctionnalités complètes pourrait transformer sa nature au point de ne plus servir son objectif principal ou d'entraîner un fardeau disproportionné pour l'éditeur. Par conséquent, l'accessibilité de cet eBook peut être limitée. Voir plus

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.

Tout le contenu de ce site: Copyright © 2026 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.