561 - Impact of Placental Inflammation on Delivery Room Resuscitation Among Newborns with Ischemic Brain Injury

Publication Number: 3542.561

Abigail Orsinelli, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; John Ibrahim, University of Texas Southwestern Medical School, Dallas, TX, United States; Monica Naik, UPMC, Pittsburgh, PA, United States; Toby Yanowitz, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: Chorioamnionitis (CA) is a known risk factor for perinatal arterial ischemic stroke (PAIS) and hypoxic ischemic encephalopathy (HIE). The extent to which placental inflammation influences immediate neonatal outcomes, particularly resuscitation required in the delivery room (DR), is unclear.

Objective: We hypothesized that higher degrees of maternal and fetal placental inflammation would be associated with lower Apgar scores and more DR resuscitation for infants with PAIS and HIE.

Design/Methods: We identified infants with seizures born 1/1/13-4/30/24 in the NICU database of UPMC Magee-Womens Hospital. Those with PAIS or HIE were included in the study. A retrospective medical record review was conducted to extract antepartum diagnoses, placental histology findings, and DR interventions. Apgar scores and need for DR CPAP or intubation were assessed relative to CA and the maternal and fetal placental inflammatory response (MIR and FIR, respectively). MIR and FIR stages were assigned scores 0-3 according to the degree of histologic placental inflammation. Statistical analysis included chi-square and Kruskal-Wallis as appropriate.

Results: We included 61 infants (33 PAIS, 31 HIE, 3 had both diagnoses). Infant demographics are shown in Table 1. CA was associated with CPAP, but not intubation, in the DR in all infants with brain injury (p = 0.008) and PAIS (Table 1, p = 0.008) but not in infants with HIE (p = 0.141). Apgar score at 1-min was lower in the presence of CA in all infants with brain injury (p=0.017) and PAIS (p=0.002) but not in infants with HIE (p=0.229). Apgar score at 5-min was lower in the presence of CA in all infants with brain injury (p=0.041) but not PAIS (p=0.056) or HIE (p=0.106). MIR stage was higher for infants requiring CPAP in the DR among infants with PAIS (Fig 1; med[IQR]: 1[0.25,2] vs 0[0,1], p = 0.018) but not HIE (p = 0.068). Apgar score at 1-min was lower for higher MIR stages among infants with PAIS (Fig 2, p = 0.018) but not HIE (p = 0.112). No significant association was observed between MIR and FIR stage and DR intubation or 5-minute Apgar score in either group.

Conclusion(s): Infants with PAIS are more likely to require CPAP in the delivery room when chorioamnionitis is present, proportional to higher maternal, but not fetal, placental inflammatory response. This same association is not found among infants with HIE, who require higher levels of resuscitation at baseline. Future larger-scale studies may further elucidate the relationship between placental pathology and delivery room preparedness for infants at risk of PAIS, which can assist with counseling parents after delivery.

Table 1
Demographics and delivery room resuscitation needs for infants with PAIS and HIE (*the 3 infants with both PAIS and HIE are included in both categories).

Figure 1
Relationship between CPAP in the delivery room and MIR stage among infants with PAIS (a) and HIE (b) and between CPAP in the delivery room and FIR stage among infants with PAIS (c) and HIE (d).

Figure 2
Relationship between 1-minute Apgar and MIR stage among infants with PAIS (a) and HIE (b) and between 1-minute Apgar and FIR stage among infants with PAIS (c) and HIE (d).