Role of vascularization in determining the time of hypoxic-ischemic encephalopathy in the neonate.

Objective: To examine the role of vascularization in determining the time of hypoxic-ischemic encephalopathy (HIEP).

Study Design: Brain sections of 126 neonatal autopsy cases were examined for edema, gliosis, congestion, inflammation and ischemia. Capillary vessels were examined with both reticulum stains and antibody against CD34. Vascular surface density (VSD) and number of vessels per stroma (NVES) were calculated by stereologic methods.

Results: Among 126 cases, 64 were male (50.8%) and 62 female (49.2%). In 25 cases HIEP was observed; 14 had a pregnancy history of hypertension, eclampsia or diabetes mellitus in the mother, with fetal distress or underdeveloped features. Statistically, NVES was strongly related to primary HIEP. However, the HIEP and non-HIEP cases revealed no differences in NVES and VSD means.

Conclusion: Vascularization, especially NVES, helps in determining whether an HIEP case is pregnancy related or due to end-stage changes of dying, but is not an indicator of HIEP.