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Clinical Trial
. 2020 Apr;87(5):879-884.
doi: 10.1038/s41390-019-0493-6. Epub 2019 Jul 1.

Placental pathology and neonatal brain MRI in a randomized trial of erythropoietin for hypoxic-ischemic encephalopathy

Yvonne W Wu  1   2 , Amy M Goodman  3 , Taeun Chang  4   5   6 , Sarah B Mulkey  4   5   6 , Fernando F Gonzalez  7 , Dennis E Mayock  8 , Sandra E Juul  8 , Amit M Mathur  9 , Krisa Van Meurs  10 , Robert C McKinstry  11 , Raymond W Redline  12
Affiliations
Clinical Trial

Placental pathology and neonatal brain MRI in a randomized trial of erythropoietin for hypoxic-ischemic encephalopathy

Yvonne W Wu et al. Pediatr Res. 2020 Apr.

Abstract

Background: Newborns with hypoxic-ischemic encephalopathy (HIE) may exhibit abnormalities on placental histology. In this phase II clinical trial ancillary study, we hypothesized that placental abnormalities correlate with MRI brain injury and with response to treatment.

Methods: Fifty newborns with moderate/severe encephalopathy who received hypothermia were enrolled in a double-blind, placebo-controlled trial of erythropoietin for HIE. A study pathologist reviewed all available clinical pathology reports to determine the presence of chronic abnormalities and acute chorioamnionitis. Neonatal brain MRIs were scored using a validated HIE scoring system.

Results: Placental abnormalities in 19 of the 35 (54%) patients with available pathology reports included chronic changes (N = 13), acute chorioamnionitis (N = 9), or both (N = 3). MRI subcortical brain injury was less common in infants with a placental abnormality (26 vs. 69%, P = 0.02). Erythropoietin treatment was associated with a lower global brain injury score (median 2.0 vs. 11.5, P = 0.003) and lower rate of subcortical brain injury (33 vs. 90%, P = 0.01) among patients with no chronic placental abnormality but not in patients whose placentas harbored a chronic abnormality.

Conclusion: Erythropoietin treatment was associated with less brain injury only in patients whose placentas exhibited no chronic histologic changes. Placentas may provide clues to treatment response in HIE.

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References

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