title: Antenatal brain injury in third trimester neonates with severe congenital anomalies: an autopsy study.
abstract: OBJECTIVE
  With advances in therapy, more neonates with severe congenital anomalies are surviving, albeit some with neurologic disorders, possibly related to antenatal low brain blood flow. This autopsy series reports antenatal brain injury in neonates expiring due to severe anomalies, and provides correlation with umbilical cord blood gas and acid-base analysis.
  
  
  METHODS
  We identified autopsies of third trimester neonates expiring shortly following delivery due to severe anomalies or malformations. Brain injury classified as "older" included periventricular leukomalacia, gliosis and karyorrhectic neurons, and "recent" included red neurons and reactive glial changes.
  
  
  RESULTS
  We identified 22 cases (nine term, 13 preterm). 16 (73%) had brain injury, including 11 with older injury. Cord arterial blood was analyzed in 17, and six had pH <7 or base deficit >12 mmol/L. Four out of 5 (80%) neonates with neuronal necrosis compared to two out of 12 (17%) without had a pH <7 or base deficit >12 mmol/L (p = 0.03). Five out of nine (56%) neonates with white matter injury compared to one out of 8 (13%) without had pH <7 or base deficit >12 mmol/L (p = NS).
  
  
  CONCLUSIONS
  Antenatal brain injury is frequent in neonates with severe congenital anomalies. Severely abnormal cord blood analysis results correlate significantly with neuronal necrosis and show a trend toward white matter injury; however, the absence of these abnormal results does not preclude the presence of brain injury.
authors.affiliation: a Department of Pathology , Hutzel Women's Hospital, Detroit Medical Center, Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Jacques
authors.forename: William J
authors.initials: WJ
authors.lastname: Kupsky
authors.forename: Faisal
authors.initials: F
authors.lastname: Qureshi
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy; D001927:Brain Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D000013:Congenital Abnormalities / Q000196:embryology* / Q000503:physiopathology; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005315:Fetal Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D009336:Necrosis; D009474:Neurons / Q000473:pathology; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third
keywords: Neuronal necrosis; neuropathology; perinatal death; periventricular leukomalacia; umbilical cord blood analysis