The correlation between the placental pathology and the neurological outcome of neonates ≥ 36 weeks with neonatal encephalopathy treated with therapeutic hypothermia

Abrahams, Ilhaam (2018-11)

Thesis (MMed)--Stellenbosch University, 2018.

Thesis

ENGLISH ABSTRACT: Introduction Perinatal asphyxia resulting in neonatal encephalopathy (NE) remains one of the commonest causes of death and morbidity in term infants in low and middle income countries. The cause of NE frequently remains unknown and its clinical presentation unanticipated. Numerous researchers are looking for biomarkers to predict the development of NE. Aim The aim of this study was to determine the relationship between placental pathology in neonates with NE treated with therapeutic hypothermia (TH) at Tygerberg Hospital (TBH) Neonatal Intensive Care Unit (NICU) and their neurodevelopmental outcome. Methods Cases were derived from a prospectively collected database of 224 neonates ≥ 36 weeks with NE who underwent TH at TBH, between January 2010 and September 2014. The study sample comprised of 17 cases remaining once 23 deaths, 173 cases with no placental pathology and 11 cases with no neurodevelopmental assessment were excluded. Placental samples from high risk neonates delivering at TBH with no evidence of NE (n=30), were derived from a list of 1787 placental samples provided by the National Health Laboratory Service (NHLS) for comparison. All placentas were re-reviewed by an experienced pathologist and all neurodevelopmental assessments were done by a single specialist. Results Cerebral palsy (CP) occurred in 44% of the NE group. Villitis of unknown aetiology (VUE) was the single significant placental lesion associated with both neonatal encephalopathy (NE) (p=0.01) and CP (p=0.005) while chorioamnionitis, the commonest placental lesion in both groups, was not significantly different between the 2 groups. The survival to one year in the NE group was 89.9%. The placental pathology submission rate was only 13%. Conclusion As VUE was demonstrated to have a significant association with NE and CP, placental histopathology is an important predictor of neurodevelopmental outcome in neonates being treated for NE with therapeutic hypothermia. Improved placental submission needs attention.

AFRIKAANSE OPSOMMING: Inleiding Perinatale asfiksie wat neonatale ensefalopatie (NE) veroorsaak bly een van die algemeenste oorsake van dood en morbiditeit in voltydse neonate in lae en middel inkomste lande. Die oorsake van NE bly in menige gevalle onbekend en die kliniese voorkoms word dikwels nie voorsien nie. Vir die rede soek navorsers biomerkers wat die voorkoms van NE voorspel. Doel: Die doel van die studie is om die verwantskap tussen plasentale patologie in neonate met NE, wat behandel word met terapeutiese hipotermie (TH) in die Neonatale Intensiewe sorgeenheid, Tygerberg Hospitaal (TBH), en neuro-ontwikkelings uitkoms te bepaal. Metodes: Die gevalle is gekies van ʼn prospektiewe versamelde databasis van 224 neonate ≥ 36 weke wat NE onderlêde het en TH ondergaan het tussen Januarie 2010 en September 2014. ʼn Groep van 17 gevalle het oorgebly nadat 23 sterftes, 173 gevalle sonder plasentale patologie en 11 gevalle sonder ʼn neuro-ontwikkelingsondersoek uitgesluit is. Neonate van hoë risiko swangerskappe met geen tekens van NE (n=30) is verkry van ʼn lys van 1787 plasentale monsters wat deur die Nasionale Gesondheid Laboratoriumdiens (NHLS) voorsien is. Al die plasentale monsters is herondersoek deur ʼn senior patoloog en al die neuroontwikkelingsondersoeke is deur ʼn senior spesialis uitgevoer. Resultate: Serebrale verlamming (SV) het in 44% van die NE groep voorgekom. Villitis van onbekend oorsaak (VOO) was die enkel plasentale letsel wat geassosieer is met NE (p=0.01) en SV (p=0.005). Chorioamnionitis, die algemeenste plasentale patologie in beide groepe, het nie statisties verskil tussen die 2 groepe nie. Die een jaar oorlewing in die NE groep was 89.9%. Die proporsie van plasentas gestuur vir ondersoek was 13%. Gevolgtrekking: Omdat VOO ʼn betekenisse assosiasie het met NE en SV bevestig dit dat plasentale patologie ʼn belangrike voorspeller is van neuro-ontwikkeling in neonate wat vir NE deur middel van TH behandel word. Verbeterde verwysing van plasentas vir ondersoek moet aandag kry.

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