Placental pathology and outcome after perinatal asphyxia and therapeutic hypothermia

OBJECTIVE: To assess the relationship between placental pathology, pattern of brain injury and neurodevelopmental outcome in term infants with perinatal asphyxia receiving therapeutic hypothermia. STUDY DESIGN: Studies were performed in 76 infants. Death or survival with impairments at 18 to 24 months was used as a composite adverse outcome. Multivariable analysis was performed. RESULTS: Among the 75 infants analyzed, the predominant pattern of brain injury was: no injury (n = 27), a white matter/watershed pattern (n = 14), basal-ganglia-thalamic injury (n = 13) or near-total brain injury (n = 21). An adverse outcome was seen in 35 of the 76 infants. Elevated nucleated red blood cells were associated with white matter involvement. Small placental infarcts were more common among infants without brain injury. All other placental abnormalities were not related to both outcome measures. CONCLUSION: In our population of term infants receiving therapeutic hypothermia, no type of placental pathology was related to extensive brain injury or adverse neurodevelopmental outcome.