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

Methods

Results

Discussion

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

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Vol 237

P. 190-196 - octobre 2021 Retour au numéro

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

Abstract

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Study design

Results

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Trial registration

Plan

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