Placental pathology in full-term infants with hypoxic-ischemic neonatal encephalopathy and association with magnetic resonance imaging pattern of brain injury

J Pediatr. 2013 Oct;163(4):968-95.e2. doi: 10.1016/j.jpeds.2013.06.010. Epub 2013 Jul 25.


Objective: To investigate the relationship between placental pathology and pattern of brain injury in full-term infants with neonatal encephalopathy after a presumed hypoxic-ischemic insult.

Study design: The study group comprised full-term infants with neonatal encephalopathy subsequent to presumed hypoxia-ischemia with available placenta for analysis who underwent cerebral magnetic resonance imaging (MRI) within the first 15 days after birth. Macroscopic and microscopic characteristics of the placenta were assessed. The infants were classified according to the predominant pattern of brain injury detected on MRI: no injury, predominant white matter/watershed injury, predominant basal ganglia and thalami (BGT) injury, or white matter/watershed injury with BGT involvement. Maternal and perinatal clinical factors were recorded.

Results: Placental tissue was available for analysis in 95 of 171 infants evaluated (56%). Among these 95 infants, 34 had no cerebral abnormalities on MRI, 27 had white matter/watershed injury, 18 had BGT injury, and 16 had white matter/watershed injury with BGT involvement. Chorioamnionitis was a common placental finding in both the infants without injury (59%) and those with white matter/BGT injury (56%). On multinomial logistic regression analysis, white matter/watershed injury with and without BGT involvement was associated with decreased placental maturation. Hypoglycemia was associated with an increased risk of the white matter/BGT injury pattern (OR,5.4; 95% CI, 1.4-21.4). The BGT injury pattern was associated with chronic villitis (OR, 12.7; 95% CI, 2.4-68.7). A placental weight <10th percentile appeared to be protective against brain injury, especially for the BGT pattern (OR, 0.1; 95% CI, 0.01-0.7).

Conclusion: Placental weight <10th percentile was mainly associated with normal cerebral MRI findings. Decreased placental maturation and hypoglycemia <2.0 mmol/L were associated with increased risk of white matter/watershed injury with or without BGT involvement. Chronic villitis was associated with BGT injury irrespective of white matter injury.

Keywords: 10th percentile; Amplitude-integrated electroencephalography; BGT; BW; Basal ganglia and thalami; Birth weight; C-reactive protein; CRP; DWI; Diffusion-weighted imaging; GA; Gestational age; HI; Hypoxia-ischemia; IL; IUGR; Interleukin; Intrauterine growth restriction; MRI; Magnetic resonance imaging; NRBC; Nucleated red blood cell; PW; Placental weight; SCM; Syncytiocapillary membrane; aEEG; p10.

MeSH terms

  • Basal Ganglia / pathology
  • Brain / pathology*
  • Female
  • Humans
  • Hypoxia, Brain / pathology
  • Hypoxia-Ischemia, Brain / pathology*
  • Infant, Newborn
  • Intensive Care, Neonatal
  • Magnetic Resonance Imaging*
  • Male
  • Organ Size
  • Placenta / pathology*
  • Pregnancy
  • Regression Analysis
  • Risk Factors
  • Thalamus / pathology