Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

Hdl Handle:
http://hdl.handle.net/10147/206239
Title:
Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.
Authors:
Murray, Deirdre M; O'Riordan, Mairead N; Horgan, Richard; Boylan, Geraldine; Higgins, John R; Ryan, Cornelius A
Affiliation:
Department of Paediatrics and Child Health, University College Cork, Cork, University Maternity Hospital, Cork, Wilton, Cork, Ireland. d.murray@ucc.ie
Citation:
Am J Perinatol. 2009 Sep;26(8):605-12. Epub 2009 Apr 27.
Journal:
American journal of perinatology
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206239
DOI:
10.1055/s-0029-1220774
PubMed ID:
19399706
Abstract:
Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24/35 (69%), suspicious in 8/35 (23%), and pathological in 3/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.
Language:
eng
MeSH:
*Cardiotocography; *Child Development; *Electroencephalography; Fetal Monitoring; *Heart Rate, Fetal; Humans; Hypoxia-Ischemia, Brain/complications/*physiopathology; Infant; Infant, Newborn; *Neurologic Examination; Seizures/complications
ISSN:
1098-8785 (Electronic); 0735-1631 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMurray, Deirdre Men_GB
dc.contributor.authorO'Riordan, Mairead Nen_GB
dc.contributor.authorHorgan, Richarden_GB
dc.contributor.authorBoylan, Geraldineen_GB
dc.contributor.authorHiggins, John Ren_GB
dc.contributor.authorRyan, Cornelius Aen_GB
dc.date.accessioned2012-01-31T16:43:07Z-
dc.date.available2012-01-31T16:43:07Z-
dc.date.issued2012-01-31T16:43:07Z-
dc.identifier.citationAm J Perinatol. 2009 Sep;26(8):605-12. Epub 2009 Apr 27.en_GB
dc.identifier.issn1098-8785 (Electronic)en_GB
dc.identifier.issn0735-1631 (Linking)en_GB
dc.identifier.pmid19399706en_GB
dc.identifier.doi10.1055/s-0029-1220774en_GB
dc.identifier.urihttp://hdl.handle.net/10147/206239-
dc.description.abstractDespite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24/35 (69%), suspicious in 8/35 (23%), and pathological in 3/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.en_GB
dc.language.isoengen_GB
dc.subject.mesh*Cardiotocographyen_GB
dc.subject.mesh*Child Developmenten_GB
dc.subject.mesh*Electroencephalographyen_GB
dc.subject.meshFetal Monitoringen_GB
dc.subject.mesh*Heart Rate, Fetalen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHypoxia-Ischemia, Brain/complications/*physiopathologyen_GB
dc.subject.meshInfanten_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.mesh*Neurologic Examinationen_GB
dc.subject.meshSeizures/complicationsen_GB
dc.titleFetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.en_GB
dc.contributor.departmentDepartment of Paediatrics and Child Health, University College Cork, Cork, University Maternity Hospital, Cork, Wilton, Cork, Ireland. d.murray@ucc.ieen_GB
dc.identifier.journalAmerican journal of perinatologyen_GB
dc.description.provinceMunster-

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