Neuroplacental Interactions in early human development: Insights from selective acute neuronal necrosis

The correct development of the central nervous system depends largely on the last two trimesters of gestation and the early neonatal period. Neurological lesions are common in autopsies, being one of the most relevant, selective acute neuronal necrosis, a manifestation of hypoxic-ischemic encephalopathy. This study aimed to analyse the distribution of selective acute neuronal necrosis (SANN) and its association with placental lesions, clinical factors and other central nervous system (CNS) abnormalities.

From 1090 autopsies performed, 205 cases (18.8 %) with SANN were identified. Placental diagnoses followed the Amsterdam Consensus. Statistical analysis included logistic regression and non-parametric tests.

Placental examination was available in 122 of the 205 SANN cases. The most frequent placental patterns were maternal vascular malperfusion in 55.7 %, fetal vascular malperfusion in 38.5 %, chronic villitis in 31.1 %, and ascending intrauterine infection in 24.6 %. The presence of placental lesions was significantly associated with increased risk of cerebral neocortex and pons involvement. Lower gestational age (GA) was associated with basal ganglia and cerebellar cortex involvement, whereas higher GA was linked to cerebral neocortex involvement. Live-born individuals presented more hippocampal and midbrain involvement. Males showed more hippocampal involvement, and females more cerebellar cortex involvement. Other CNS abnormalities were found in 71.3 % of SANN cases, mainly gray matter gliosis (60 %), white matter gliosis (43.4 %), haemorrhages (30.2 %), and neuronal migration disorders (8.8 %).

These findings highlight the close relationship between placental lesions and SANN, supporting the importance of CNS and placental assessment in these autopsies.