title: Hypoxic ischemic encephalopathy in newborns linked to placental and umbilical cord abnormalities.
abstract: OBJECTIVE
  Birth asphyxia and hypoxic ischemic encephalopathy (HIE) of the newborn remain serious complications. We present a study investigating if placental or umbilical cord abnormalities in newborns at term are associated with HIE.
  
  
  METHODS
  A prospective cohort study of the placenta and umbilical cord of infants treated with hypothermia (HT) due to hypoxic brain injury and follow-up at 12 months of age has been carried out. The study population included 41 infants treated for HT whose placentas were submitted for histopathological analysis. Main outcome measures were infant development at 12 months, classified as normal, cerebral palsy, or death. A healthy group of 100 infants without HIE and normal follow-up at 12 months of age were used as controls.
  
  
  RESULTS
  A velamentous or marginal umbilical cord insertion and histological abruption was associated with the risk of severe HIE, OR = 5.63, p = 0.006, respectively, OR = 20.3, p = 0.01 (multiple-logistic regression). Velamentous or marginal umbilical cord insertion was found in 39% among HIE cases compared to 7% in controls.
  
  
  CONCLUSIONS
  Placental and umbilical cord abnormalities have a profound association with HIE. A prompt examination of the placentas of newborns suffering from asphyxia can provide important information on the pathogenesis behind the incident and contribute to make a better early prognosis.
authors.affiliation: a Department of Obstetrics & Gynaecology , Karolinska University Hospital , Stockholm , Sweden .
authors.forename: Josefine
authors.initials: J
authors.lastname: Nasiell
authors.affiliation: b Department of Laboratory Medicine, Division of Pathology , Section of Perinatal Pathology, Karolinska Institute , Stockholm , Sweden .|c Karolinska University Hospital , Stockholm , Sweden , and.
authors.forename: Nikos
authors.initials: N
authors.lastname: Papadogiannakis
authors.affiliation: a Department of Obstetrics & Gynaecology , Karolinska University Hospital , Stockholm , Sweden .
authors.forename: Erika
authors.initials: E
authors.lastname: Löf
authors.affiliation: a Department of Obstetrics & Gynaecology , Karolinska University Hospital , Stockholm , Sweden .
authors.forename: Fanny
authors.initials: F
authors.lastname: Elofsson
authors.affiliation: d Department of Neonatalogy , Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Boubou
authors.initials: B
authors.lastname: Hallberg
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000150:complications* / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000151:congenital / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D010920:Placenta / Q000002:abnormalities*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D047929:Term Birth; D014470:Umbilical Cord / Q000002:abnormalities*; D054079:Vascular Malformations / Q000150:complications* / Q000453:epidemiology
keywords: Hypoxic ischemic encephalopathy; newborns; placenta; umbilical cord; velamentous/marginal insertion