Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
J Pediatr. 2013 Oct;163(4):968-95.e2. doi: 10.1016/j.jpeds.2013.06.010. Epub 2013 Jul 25.
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.
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.
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).
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.
探讨足月新生儿缺氧缺血性脑病（HIE）后脑损伤模式与胎盘病理的关系。
研究组纳入了 95 例（56%）有胎盘可供分析的疑似缺氧缺血性 HIE 足月新生儿，所有患儿均在出生后 15 天内进行了脑磁共振成像（MRI）检查。评估胎盘的大体和微观特征。根据 MRI 检测到的主要脑损伤模式对患儿进行分类：无损伤、以脑白质/分水岭损伤为主、以基底节和丘脑（BGT）损伤为主或以脑白质/分水岭损伤合并 BGT 损伤为主。记录产妇和围生期临床资料。
171 例患儿中有 95 例（56%）的胎盘组织可用于分析。在这 95 例患儿中，34 例 MRI 未见脑异常，27 例有脑白质/分水岭损伤，18 例有 BGT 损伤，16 例有脑白质/分水岭损伤合并 BGT 损伤。绒毛膜羊膜炎是无损伤组（59%）和脑白质/BGT 损伤组（56%）中常见的胎盘表现。多变量逻辑回归分析显示，伴有或不伴有 BGT 损伤的脑白质/分水岭损伤与胎盘成熟度降低有关。低血糖与脑白质/BGT 损伤模式的风险增加相关（OR，5.4；95%CI，1.4-21.4）。BGT 损伤模式与慢性绒毛膜炎相关（OR，12.7；95%CI，2.4-68.7）。胎盘重量＜第 10 百分位数似乎可预防脑损伤，尤其是对 BGT 模式（OR，0.1；95%CI，0.01-0.7）。
胎盘重量＜第 10 百分位数主要与脑 MRI 正常结果相关。胎盘成熟度降低和＜2.0mmol/L 的低血糖与伴有或不伴有 BGT 损伤的脑白质/分水岭损伤风险增加有关。慢性绒毛膜炎与 BGT 损伤有关，而与脑白质损伤无关。
