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

Abstract

IntroductionPlacental 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.ObjectiveTo determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival.Patients and methodsThis 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.ResultsTwenty 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).ConclusionsDepressed 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.

Encefalopatía neonatal de origen inflamatorio-infeccioso. Reporte de caso y revisión de la literatura

“…Se han descrito alteraciones en el registro de EEGa en recien nacidos con antecedentes de corioamnionitis. La liberación de citoquinas proinflamatorias maternas y/o fetales, (especialmente IL-1 e IL-6) sería perjudicial para el sistema nervioso fetal en desarrollo, y su posible efecto se vería reflejado en cambios en la actividad eléctrica cerebral 11 .…”

Comparison of conventional, amplitude-integrated and geodesic sensor net EEG used in premature neonates: a systematic review

“…Lately, the use of this technique has been increasing, especially in NICUs 24,25 . This technique allows a continuous and noninvasive monitoring of brain function 23,24,26 , accessible as a bedside technology because of its compact size 7,22 , and it is very useful in assessing the maturation of electrocortical activity in preterm and full-term neonates in NICUs 14,24,27 .…”

“…Increasingly, aEEG is also cited in the literature for specific diseases and conditions that may affect the normal neurodevelopment of the neonate, especially premature infants. Placental lesions consistent with intrauterine infection with fetal involvement are one of the causes of the absence of aEEG cycling in the first day of life of those born at 28 weeks of gestation 25 . In addition, placental lesions consistent with low maternal perfusion were associated with depressed brain activity during the first two days of life and lower overall brain activity during the first three days of life.…”

Chorioamnionitis, IL‐17A, and fetal origins of neurologic disease

“…Remarkably, nearly one-half of all infants born before 30 weeks’ GA manifest some degree of white matter injury on serial MRI 85 . Infants exposed to chorioamnionitis prior to 28 weeks’ GA also experienced depressed patterns on amplitude integrated EEG (aEEG) indicating early brain injury 86 . Recent studies confirm that preterm birth alone is insufficient to cause fetal neuronal aberrations associated with neuroinflammation and white matter injury, but must occur concurrently with in utero inflammation 71, 87 .…”