Abstract
Objective
To determine if pre-specified placental abnormalities among newborns with hypoxic–ischemic encephalopathy (HIE) differ compared to newborns admitted to a NICU without encephalopathy.
Study Design
Retrospective case–control study of newborns with HIE (2006–2014) and controls matched for birth year, gestational age, weight, and gender. One pathologist reviewed archived placental sections using pre-specified criteria.
Results
Sixty-seven newborns had HIE, 46 had available placentas and were matched with 92 controls. HIE had more maternal vascular malperfusion (46% vs 25%, p = 0.02), fetal vascular malperfusion (13% vs 0%, p < 0.001), and clinical abruption (22% vs 4%, p = 0.001). Controls had more normal placentas (29% vs 7%, p = 0.002), and chorioamnionitis (30% vs 9%, p = 0.005). Pre-specified placental lesions occurred in 87% of HIE and 65% of controls (p = 0.008) and identified >90% of primary diagnoses.
Conclusions
Pre-specified placental lesions identified nearly all abnormalities in HIE and represented both acute and chronic processes.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
American College of Obstetricians and Gynecologists, American Academy of Pediatrics. Neonatal encephalopathy and neurologic outcome. 2nd ed. Washington, DC: American College of Obstetricians and Gynecologists; 2014.
Roescher AM, Timmer A, Erwich JJ, Bos AF. Placental pathology, perinatal death, neonatal outcome, and neurological development: a systematic review. PLoS ONE. 2014;9:e89419.
Redline RW. Severe fetal placental vascular lesions in term infants with neurologic impairment. Am J Obstet Gynecol. 2005;192:452–7.
Redline RW, O’Riordan MA. Placental lesions associated with cerebral palsy and neurologic impairment following term birth. Arch Pathol Lab Med. 2000;124:1785–91.
Nelson KB, Blair E. The placenta and neurologic and psychiatric outcomes in the child: study design matters. Placenta. 2011;32:623–5.
Redline RW. Cerebral palsy in term infants: a clinicopathologic analysis of 158 medicolegal case reviews. Pediatr Dev Pathol. 2008;11:456–64.
Hayes BC, Cooley S, Donnelly J, Doherty E, Grehan A, Madigan C, et al. The placenta in infants >36 weeks gestation with neonatal encephalopathy: a case control study. Arch Dis Child Fetal Neonatal Ed. 2013;98:F233–9.
Mir IN, Johnson-Welch SF, Nelson DB, Brown LS, Rosenfeld CR, Chalak LF. Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia. Am J Obstet Gynecol. 2015;213:849 e841–7.
Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005;353:1574–84.
Shankaran S, Laptook AR, Pappas A, McDonald SA, Das A, Tyson JE, et al. Effect of depth and duration of cooling on death or disability at age 18 months among neonates with hypoxic-ischemic encephalopathy: a randomized clinical trial. JAMA. 2017;318:57–67.
Pinar H, Sung CJ, Oyer CE, Singer DB. Reference values for singleton and twin placental weights. Pediatr Pathol Lab Med. 1996;16:901–7.
Lurie S, Feinstein M, Mamet Y. Human fetal-placental weight ratio in normal singleton near-term pregnancies. Gynecol Obstet Invest. 1999;48:155–7.
Strong TH Jr, Jarles DL, Vega JS, Feldman DB. The umbilical coiling index. Am J Obstet Gynecol. 1994;170(Pt 1):29–32.
Khong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler MA, et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016;140:698–713.
Kramer MS, Usher RH, Pollack R, Boyd M, Usher S. Etiologic determinants of abruptio placentae. Obstet Gynecol. 1997;89:221–6.
Tai M, Piskorski A, Kao JC, Hess LA, MdlM S, Gundogan F. Placental morphology in fetal alcohol spectrum disorders. Alcohol Alcohol. 2017;52:138–44.
Rand K, Bingham A, Laptook A, Gundogan F. Placental abnormalities in uncomplicated term pregnancies. Pediatr Dev Pathol. 2017;20:533–4.
Wintermark P, Boyd T, Gregas MC, Labrecque M, Hansen A. Placental pathology in asphyxiated newborns meeting the criteria for therapeutic hypothermia. Am J Obstet Gynecol. 2010;203:579 e571–9.
McDonald DG, Kelehan P, McMenamin JB, Gorman WA, Madden D, Tobbia IN, et al. Placental fetal thrombotic vasculopathy is associated with neonatal encephalopathy. Hum Pathol. 2004;35:875–80.
Harteman JC, Nikkels PG, Benders MJ, Kwee A, Groenendaal F, de Vries LS. Placental pathology in full-term infants with hypoxic-ischemic neonatal encephalopathy and association with magnetic resonance imaging pattern of brain injury. J Pediatr. 2013;163:968–95 e962.
Nasiell J, Papadogiannakis N, Lof E, Elofsson F, Hallberg B. Hypoxic ischemic encephalopathy in newborns linked to placental and umbilical cord abnormalities. J Matern Fetal Neonatal Med. 2016;29:721–6.
Chang T, Reyes C, Teng J, Placette J, Massaro AN, Nelson KB. Neonatal encephalopathy, sentinel events, and the placenta. J Neonatal-Perinat Med. 2012;5:41–8.
Lachapelle J, Chen M, Oskoui M, Ali N, Brown R, Wintermark P. Placental pathology in asphyxiated newborns treated with therapeutic hypothermia. J Neonatal-Perinat Med. 2015;8:33–40.
Kraus FT, Acheen VI. Fetal thrombotic vasculopathy in the placenta: cerebral thrombi and infarcts, coagulopathies, and cerebral palsy. Hum Pathol. 1999;30:759–69.
Wu YW, Croen LA, Shah SJ, Newman TB, Najjar DV. Cerebral palsy in a term population: risk factors and neuroimaging findings. Pediatrics. 2006;118:690–7.
Wu YW, Escobar GJ, Grether JK, Croen LA, Greene JD, Newman TB. Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA. 2003;290:2677–84.
Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR, et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ. 1998;317:1554–8.
Funding
Financial support for this study was provided by the Department of Pediatrics, Women and Infants Hospital of Rhode Island. The study design, collection, analysis and interpretation of data and the writing of this report is a product of the involved investigators and the Department of Pediatrics did not play a role in any aspect of the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Bingham, A., Gundogan, F., Rand, K. et al. Placental findings among newborns with hypoxic ischemic encephalopathy. J Perinatol 39, 563–570 (2019). https://doi.org/10.1038/s41372-019-0334-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41372-019-0334-9
This article is cited by
-
The association of placental pathology and neurodevelopmental outcomes in patients with neonatal encephalopathy
Pediatric Research (2023)
-
The impact of placental genomic risk for schizophrenia and birth asphyxia on brain development
Translational Psychiatry (2023)
-
Association of perinatal sentinel events, placental pathology and cerebral MRI in neonates with hypoxic-ischemic encephalopathy receiving therapeutic hypothermia
Journal of Perinatology (2022)
-
Placental Histopathology and Pregnancy Outcomes in “Early” vs. “Late” Placental Abruption
Reproductive Sciences (2021)