Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience

Abstract

Objectives Although neonates with moderate to severe hypoxic ischemic encephalopathy (HIE) receive therapeutic hypothermia (TH), 40–50% die or have significant neurological disability. The aim of this study is to analyse the association of placental pathology and neurodevelopmental outcome in cooled neonates with HIE at 18–24 months of age. Methods Retrospective analysis of prospectively collected data on 120 neonates registered in the Swiss National Asphyxia and Cooling Register born between 2007 and 2017. This descriptive study examines the frequency and range of pathologic findings in placentas of neonates with HIE. Placenta pathology was available of 69/120 neonates, whose results are summarized as placental findings. As neonates with HIE staged Sarnat score 1 (21/69) did not routinely undergo follow-up assessments and of six neonates staged Sarnat Score 2/3 no follow-up assessments were available, 42/48 (88%) neonates remain to assess the association between placental findings and outcome. Results Of the 42/48 (88%) neonates with available follow up 29% (12/42) neonates died. Major placenta abnormalities occurred in 48% (20/42). Major placenta abnormality was neither associated with outcome at 18–24 months of age (OR 1.75 [95% CI 0.50–6.36, p=0.381]), nor with death by 2 years of age (OR 1.96 [95% CI 0.53–7.78, p=0.320]). Conclusions In this study cohort there could not be shown an association between the placenta findings and the neurodevelopmental outcome at 18–24 months of age.

Leveraging the placenta to advance neonatal care

“…Given the proximity of these biospecimens to the placenta at birth, development of these proxies seems feasible and promising. The association between placental findings and neurodevelopmental outcome in neonates with HIE is less apparent in the era of therapeutic hypothermia, suggesting that neonatal intervention is effective in uncoupling the placental-perinatal events leading up to HIE, by attenuating the acute process of brain injury and improving long-term outcomes ( 75 ).…”