Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates.

Placental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome. We hypothesized an association between types of placental lesions and abnormal neonatal aEEG patterns.To determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival.This prospective cohort study included extreme premature infants, who were born ≤ 28 weeks of gestation, their placentas were available for histologic examination, and had a continues aEEG, soon after birth)n = 34). Infants and maternal clinical data were collected. aEEG data was assessed for percentage of depressed daily activity in the first 3 days of life and for sleep cycling. Associations of placental histology with clinical findings and aEEG activity were explored using parametric and non-parametric statistics.Twenty two out of the 34 newborns survived to discharge. Preterm prelabor rupture of membranes (PPROM) or chorioamnionitis were associated with placental lesions consistent with fetal amniotic fluid infection (AFI) or maternal under perfusion (MUP) (P < 0.05). Lesions consistent with fetal response to AFI were associated with absence of SWC pattern during the 1st day of life. Fetal-vascular-thrombo-occlusive lesions of inflammatory type were negatively associated with depressed cerebral activity during the 1st day of life, and with aEEG cycling during the 2nd day of life (P<0.05). Placental lesions associated with MUP were associated with depressed neonatal cerebral activity during the first 3 days of life (P = 0.007).Depressed neonatal aEEG patterns are associated with placental lesions consistent with maternal under perfusion, and amniotic fluid infection of fetal type, but not with fetal thrombo-oclusive vascular disease of inflammatory type. Our findings highlight the association between the intrauterine mechanisms leading to preterm parturition and subsequent depressed neonatal cerebral function early after birth, which eventually may put premature infants at risk for abnormal neurodevelopmental outcome

Patterns of aEEG recordings.

<p>A: Premature infants born 27 weeks' gestation at his first day of life. Normal tracing for age, note the cycling of the lower border of the aEEG tracing. Different patterns can be depicted in this tracing: Low discontinuous (black stars), high discontinuous (white arrows) and, also, short periods of continuous activity: black arrows. On histology, fetal vascular thrombo-occlusive type lesion was observed and he had a good outcome. B: Premature infants born 27 weeks' gestation at his first day of life. Depressed tracing consisting of burst suppression pattern with a short period of isoelectric pattern (arrow). In his placenta signs of maternal underperfusion, vascular type, were observed. As to his outcome, his Bayley's screening assessment classified him at risk and the Amiel-Tison neurological exam scored moderately abnormal.</p

Association between placental histology and absence of sleep cycling.

<p>Association between placental histology and absence of sleep cycling.</p

Maternal and neonatal clinical characteristics.

<p>Maternal and neonatal clinical characteristics.</p

Patterns of aEEG recordings.

<p>A: Premature infants born at 27 weeks gestation at his first day of life. Normal tracing for age, note the cycling of the lower border of the aEEG tracing. Different patterns can be depicted in this tracing: Low discontinuous (black stars), high discontinuous (white arrows) and also short periods of continuous activity: black arrows. B: Premature infants bore 27 weeks gestation at his first day of life. Depressed tracing consisting of burst suppression pattern with a short period of isoelectric pattern (arrow).</p

Maternal and neonatal clinical characteristics and placental oathology.

<p>Maternal and neonatal clinical characteristics and placental oathology.</p

Distribution of placental lesions within thirtiles of cerebral activity.

<p>Infants with placental lesions consistent with vascular MUP were more likely to be in the highest thirtile of depressed cerebral activity. AFI: Amniotic Fluid Infection. MUP: Maternal Under Perfusion. FVTOD: Fetal Vascular Thrombo-Occlusive Disease.</p

Association between placental histology and depressed aEEG—According to the neonatal percentage of daily depressed aEEG during the first three days of life.

<p>Significant association is demonstrated between MUP of a vascular type and neonates with the most depressed aEEG recording during the first 3 days of life. AFI- Amniotic Fluid Infection; MUP-Maternal Under Perfusion; FVTOD-Fetal Vascular Thrombo-Occlusive Disease.</p