Cumulative burden of maternal vascular malperfusion and its association with early cerebral oxygenation in neonates

Objectives Maternal vascular malperfusion (MVM) represents a major cause of chronic fetal hypoxia and is associated with adverse neonatal outcomes. However, whether the cumulative burden of MVM lesions influences early cerebral oxygenation in neonates remains unclear. This study aimed to evaluate the association between the number of placental MVM lesion types and neonatal cerebral regional oxygen saturation (crSO 2 ) and cerebral fractional tissue oxygen extraction (cFTOE). Methods In this retrospective observational study, 508 neonates admitted between January 2021 and March 2024 were included. Based on placental histopathology, infants were categorized into three groups according to the number of MVM lesion types: no MVM, 1–2 MVM types, and 3–5 MVM types. Cerebral oxygenation was monitored weekly from birth to postnatal day 28 using near-infrared spectroscopy. Multivariable linear regression models were used to assess associations between MVM burden and crSO 2 /cFTOE during the first postnatal week, adjusting for relevant maternal and neonatal covariates. Results Compared with neonates without MVM, those with placental findings of 3–5 types of MVM had significantly higher crSO 2 (β = 1.65; 95% CI, 0.05–3.24; P = 0.044) and lower cFTOE (β = −0.02; 95% CI, −0.04 to −0.01; P = 0.029) during the first postnatal week. No significant differences were observed in the 1–2 MVM group. Longitudinal analyses demonstrated decreasing crSO 2 and increasing cFTOE with advancing postnatal age across all groups, with the early differences between groups attenuating over time. Conclusion A cumulative burden of 3–5 MVM types is independently associated with altered cerebral oxygenation patterns in the early neonatal period, characterized by higher crSO 2 and lower cFTOE. These findings suggest that the cumulative burden of maternal vascular malperfusion lesions identified on postpartum placental examination may provide clinically relevant contextual information for interpreting early neonatal cerebral oxygenation patterns and underscore the need for enhanced physiological monitoring during the first postnatal week.