Department of Paediatrics and Child Health

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Browsing Department of Paediatrics and Child Health by Author "Abrahams, Ilhaam"

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    The correlation between the placental pathology and the neurological outcome of neonates ≥ 36 weeks with neonatal encephalopathy treated with therapeutic hypothermia
    (Stellenbosch : Stellenbosch University, 2018-12) Abrahams, Ilhaam; Kali, Gugulabatembunamahlubi; Smith, Johan; Schubert, Pawel T.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    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.