Placental pathology in asphyxiated newborns meeting the criteria for therapeutic hypothermia.
OBJECTIVE
We sought to describe placental findings in asphyxiated term newborns meeting therapeutic hypothermia criteria and to assess whether histopathologic correlation exists between these placental lesions and the severity of later brain injury.


METHODS
We conducted a prospective cohort study of the placentas of asphyxiated newborns, in whom later brain injury was defined by magnetic resonance imaging.


RESULTS
A total of 23 newborns were enrolled. Eighty-seven percent of their placentas had an abnormality on the fetal side of the placenta, including umbilical cord lesions (39%), chorioamnionitis (35%) with fetal vasculitis (22%), chorionic plate meconium (30%), and fetal thrombotic vasculopathy (26%). A total of 48% displayed placental growth restriction. Chorioamnionitis with fetal vasculitis and chorionic plate meconium were significantly associated with brain injury (P = .03). Placental growth restriction appears to significantly offer protection against the development of these injuries (P = .03).


CONCLUSIONS
Therapeutic hypothermia may not be effective in asphyxiated newborns whose placentas show evidence of chorioamnionitis with fetal vasculitis and chorionic plate meconium.
Wintermark
Pia
P
Division of Newborn Medicine, Department of Pediatrics, Children's Hospital Boston, Boston, MA, USA. Pia.Wintermark@bluemail.ch
Boyd
Theonia
T
Gregas
Matthew C
MC
Labrecque
Michelle
M
Hansen
Anne
A
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001707:Biopsy, Needle; D001724:Birth Weight; D002821:Chorioamnionitis / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007150:Immunohistochemistry; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010922:Placenta Diseases / Q000473:pathology*; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D047929:Term Birth; D013997:Time Factors; D016896:Treatment Outcome