Placental hypoxia and neonatal haemangioma: clinical and histological observations

Conflicts of interest: none declared. Madam, Some experimental and clinical data favour the hypothesis of a relationship between placental hypoxia and neonatal haemangioma. The existence of common antigens between placenta and haemangioma, in particular GLUT‐1, has been reported.1 Expression of GLUT‐1, which facilitates glucose uptake, was found to be increased in endothelial cells in conditions of hypoxia.2 A contemporaneous presence of haemangioma and chorioangioma, the most common benign neoplasm of the placenta,3 has been described. Increased neoangiogenesis as seen in chorioangioma is the consequence of chronic placental hypoxia as well as haemangioma is preceded, in the first days of life, by precursors consisting of flat ischaemic patches.4 Recently, some authors5 found a greater incidence of placental infarctions in premature babies with haemangioma. These data led us to search for possible placental alterations in a group of newborn babies with haemangioma and in a control group. Of 55 973 babies examined in the outpatient department of the Bari Paediatric Dermatology Unit between 1994 and 2008, we detected 2001 cases (1031 girls and 970 boys) with haemangioma (sample group) and 4328 (2371 girls and 1957 boys) babies with a dermatological illness different from haemangioma (control group). We verified that 30 babies with haemangioma and 57 controls had undergone examination of their placenta in the Pathology Department. The two groups were not significantly different with regard to age of the mother and parity. With regard to gestational age, 17/30 of the newborn babies with haemangioma and 16/57 of the control babies had a gestational age of < 37 weeks. With regard to pregnancy events, 10/30 infants with haemangioma and 10/57 infants of the control group had a mother with gestosis. Each of the 87 cases underwent a review of the histological alterations of the placenta. The evaluation of hypoxia was based on the criteria of Kingdom and Kaufmann,6, 7 namely the capillary volume fraction, the branching of capillaries, the dilation of capillaries, the amount of villous cytotrophoblast and the incidence of syncytial knotting. The histological alterations due to hypoxia in the group with haemangioma were compared with placental alterations in the control group. A statistical evaluation of the difference between the placental alterations in the two groups was done by a contingency table, using the χ2 test.