OBJECTIVE We aimed to examine the association between placental abnormalities and neurodevelopmental outcomes in a multicenter cohort of newborn infants with hypoxic-ischemic encephalopathy (HIE) that underwent therapeutic hypothermia. We hypothesized that subjects with acute placental abnormalities would have reduced risk of death or neurodevelopmental impairment (NDI) at 2 years of age after undergoing therapeutic hypothermia compared to subjects without acute placental changes. STUDY DESIGN Among 500 subjects born at ≥36 weeks gestation with moderate or severe HIE enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) Trial, a placental pathologist blinded to clinical information reviewed clinical pathology reports to determine the presence of acute only, chronic only, or both acute and chronic histologic abnormalities. We calculated adjusted relative risks (aRRs) for associations between placental pathologic abnormalities and death or NDI at age 2 years, adjusting for HIE severity, treatment assignment, and site. RESULT 321/500 subjects (64%) had available placental pathology reports. Placental abnormalities were characterized as acute only (20%), chronic only (21%), both acute and chronic (43%), and none (15%). The risk of death or NDI was not statistically different between subjects with and without an acute placental abnormality (46 vs. 53%, aRR 1.1, 95% confidence interval (CI): 0.9, 1.4). Subjects with two or more chronic lesions were more likely to have an adverse outcome than subjects with no chronic abnormalities, though this did not reach statistical significance (55 vs. 45%, aRR 1.24, 95% CI: 0.99, 1.56). CONCLUSION Placental pathologic findings were not independently associated with risk of death or NDI in subjects with HIE. The relationship between multiple chronic placental lesions and HIE outcomes deserves further study.

中文翻译：

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新生儿缺氧缺血性脑病的胎盘组织学异常和 2 年结果。

目的 我们旨在研究接受低温治疗的缺氧缺血性脑病 (HIE) 新生儿多中心队列中胎盘异常与神经发育结局之间的关联。我们假设，与没有急性胎盘异常的受试者相比，接受低温治疗后，患有急性胎盘异常的受试者在 2 岁时死亡或神经发育障碍 (NDI) 的风险会降低。研究设计 在参加高剂量促红细胞生成素治疗窒息和脑病 (HEAL) 试验的 500 名妊娠≥36 周出生的患有中度或重度 HIE 的受试者中，一位对临床信息不知情的胎盘病理学家审查了临床病理报告，以确定是否存在急性仅，仅慢性，或急性和慢性组织学异常。我们计算了胎盘病理异常与 2 岁时死亡或 NDI 之间关联的调整相对风险 (aRR)，并调整了 HIE 严重程度、治疗分配和部位。结果 321/500 名受试者 (64%) 有可用的胎盘病理学报告。胎盘异常的特征为仅急性（20%）、仅慢性（21%）、急性和慢性（43%）以及无（15%）。患有和不患有急性胎盘异常的受试者之间的死亡或 NDI 风险没有统计学差异（46% vs. 53%，aRR 1.1，95% 置信区间 (CI)：0.9、1.4）。具有两个或多个慢性病变的受试者比没有慢性异常的受试者更有可能出现不良结果，尽管这没有达到统计学显着性（55 vs. 45%，aRR 1.24，95% CI：0.99，1.56）。结论 胎盘病理结果与 HIE 受试者的死亡或 NDI 风险并不独立相关。多种慢性胎盘病变与 HIE 结局之间的关系值得进一步研究。