Placental pathology as a marker of brain injury in infants with hypoxic ischemic encephalopathy.

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From: Early Human Development(Vol. 174)
Publisher: Elsevier B.V.
Document Type: Report
Length: 438 words

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Keywords Neonate; Hypoxemic ischemic encephalopathy; Placental pathology Highlights * Hypoxemic ischaemic encephalopathy (HIE) can have devastating effects on newborns. * Moderate-severe HIE, amenable to cooling, is difficult to differentiate from mild HIE. * Amsterdam classification was used to describe placental histopathology in HIE. * Placental fetal inflammatory reaction was associated with moderate-severe HIE. * The placenta should be examined in all cases of HIE. Abstract Background Hypoxic Ischemic Encephalopathy (HIE) can lead to devastating consequences for the affected infant. Although therapeutic cooling benefits infants with moderate and severe HIE, differentiating mild from moderate-severe HIE may be challenging. The placenta reflects the fetal intrauterine environment and may reveal underlying processes that affect brain injury. Aim To describe placental histopathology using the Amsterdam Placental Workshop Group Criteria in different grades of HIE. Study design Retrospective cohort. Subjects Infants admitted to a tertiary care neonatal intensive care unit with a diagnosis of HIE between 2011 and 2016. Outcome measure Maternal and neonatal clinical variables and placental histopathology using the Amsterdam Placental Workshop Group Criteria were compared between mild and moderate-severe HIE. Mann-Whitney or t-test or ê­.sup.2 were performed for bivariate associations as appropriate. To explain the relationship between placental pathology and severity of HIE odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using logistic regression models. Results Of the 73 infants in the study, 23 had mild and 50 moderate-sever HIE. There was no difference in maternal and neonatal characteristics except for sentinel events which were higher in the moderate- severe group. On placental histopathology, acute inflammation, including fetal inflammatory reaction (FIR) were significantly higher in the moderate-severe group. After adjusting for confounders, FIR remained significantly associated with moderate-severe HIE, ORs 6.29, 95 % CI 1.5--25. Conclusion Our study demonstrates FIR in the placenta is associated with severity of HIE. Abbreviations aEEG, Amplitude electroencephalogram; FIR, Fetal Inflammatory Reaction; HIE, Hypoxic Ischaemic Encephalopathy; IL, Interleukin; LGA, Large for gestational age; MIR, Maternal Inflammatory Reaction; PBW, Placental birthweight; PPV, Positive-pressure ventilation; SGA, Small gestational age; TNF, Tumor necrosis factor Author Affiliation: (a) Department of Pediatrics, University of Calgary, Section of Neonatology, Calgary, AB, Canada (b) Department of Pathology & Laboratory Medicine and Pediatrics, University of Calgary, Calgary, AB, Canada * Corresponding author at: Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Rm 273, Heritage Medical Research Building, 3330 Hospital Dr., Calgary T2N 4K3, Alberta, Canada. Article History: Received 31 July 2022; Revised 27 September 2022; Accepted 28 September 2022 Byline: Maria Liza Espinoza (a), Marie-Anne Brundler (b), Shabih U. Hasan (a), Khorshid Mohammad (a), Sarfaraz Momin (a), Belal Al Shaikh (a), Kamran Yusuf [kyusuf@ucalgary.ca] (a,*)

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Gale Document Number: GALE|A723925868