Acute and Chronic Placental Abnormalities in a Multicenter Cohort of Newborn Infants with Hypoxic–Ischemic Encephalopathy

Lina Chalak, Raymond W. Redline, Amy M. Goodman, Sandra E. Juul, Taeun Chang, Toby D. Yanowitz, Nathalie Maitre, Dennis E. Mayock, Andrea L. Lampland, Ellen Bendel-Stenzel, David Riley, Amit M. Mathur, Rakesh Rao, Krisa P. Van Meurs, Tai Wei Wu, Fernando F. Gonzalez, John Flibotte, Ulrike Mietzsch, Gregory M. Sokol, Kaashif A. AhmadMariana Baserga, Joern Hendrik Weitkamp, Brenda B. Poindexter, Bryan A. Comstock, Yvonne W. Wu

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objective: To examine the frequency of placental abnormalities in a multicenter cohort of newborn infants with hypoxic–ischemic encephalopathy (HIE) and to determine the association between acuity of placental abnormalities and clinical characteristics of HIE. Study design: Infants born at ≥36 weeks of gestation (n = 500) with moderate or severe HIE were enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy Trial. A placental pathologist blinded to clinical information reviewed clinical pathology reports to determine the presence of acute and chronic placental abnormalities using a standard classification system. Results: Complete placental pathologic examination was available for 321 of 500 (64%) trial participants. Placental abnormalities were identified in 273 of 321 (85%) and were more common in infants ≥40 weeks of gestation (93% vs 81%, P = .01). A combination of acute and chronic placental abnormalities (43%) was more common than either acute (20%) or chronic (21%) abnormalities alone. Acute abnormalities included meconium staining of the placenta (41%) and histologic chorioamnionitis (39%). Chronic abnormalities included maternal vascular malperfusion (25%), villitis of unknown etiology (8%), and fetal vascular malperfusion (6%). Infants with chronic placental abnormalities exhibited a greater mean base deficit at birth (−15.9 vs −14.3, P = .049) than those without such abnormalities. Patients with HIE and acute placental lesions had older mean gestational ages (39.1 vs 38.0, P < .001) and greater rates of clinically diagnosed chorioamnionitis (25% vs 2%, P < .001) than those without acute abnormalities. Conclusions: Combined acute and chronic placental abnormalities were common in this cohort of infants with HIE, underscoring the complex causal pathways of HIE. Trial registration:

Original languageEnglish
Pages (from-to)190-196
Number of pages7
JournalJournal of Pediatrics
StatePublished - Oct 2021


  • HIE
  • encephalopathy
  • neonate
  • placenta


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