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Attini R, Montersino B, Versino E, Messina A, Mastretta E, Parisi S, Germano C, Quattromani M, Casula V, Mappa I, Revelli A, Masturzo B. Analysis of CTG patterns in cases with metabolic acidosis at birth with and without neonatal neurological alterations. J Matern Fetal Neonatal Med 2024; 37:2377718. [PMID: 39128870 DOI: 10.1080/14767058.2024.2377718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE To determine cardiotocographic patterns in newborns with metabolic acidosis, based on clinical signs of neurological alteration (NA) and the need for hypothermic treatment. METHODS All term newborns with metabolic acidosis in a single center from 2016 to 2020 were included in the study. Three segments of intrapartum CTG (cardiotocography) were considered (first 30 min of active labor, 90 to 30 min before birth, and last 30 min before delivery) and a longitudinal analysis of CTG pattern was performed according to the 2015 FIGO classification. RESULTS Three hundred and twenty-four neonates with metabolic acidosis diagnosed at birth were divided into three groups: the first group included all neonates with any clinical sign of neurological alteration, requiring hypothermia according to the recommendation of the Italian Society of Neonatology (group TNA-Treated neurological Alteration, n = 17), the second encompassed neonates with any clinical sign of neurological alteration not requiring hypothermia (group NTNA-Not Treated neurological Alteration, n = 83), and the third enclosed all neonates without any sign of clinical neurological involvement (group NoNA-No neurological Alteration, n = 224). The most frequent alterations of CTG in TNA group were late decelerations, reduced variability, bradycardia, and tachysystole. Unexpectedly, from the longitudinal analysis of the CTG, 49% of all cases with metabolic acidosis never showed a pathological CTG with normal trace at the beginning of labor followed by normal or suspicious trace in the final part of labor, the same as in TNA and NTNA groups (10 and 39%, respectively). CONCLUSIONS CTG has limited specificity in identifying cases of acidosis at birth, even in babies who will develop NA.
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Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Benedetta Montersino
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Elisabetta Versino
- Department of Epidemiology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessandro Messina
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Emmanuele Mastretta
- Department of Neonatology, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Silvia Parisi
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Chiara Germano
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Martina Quattromani
- Department of Pediatrics and Neonatology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Viola Casula
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Tor Vergata University Hospital, Rome, Italy
| | - Alberto Revelli
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology 2U, Sant'Anna Hospital, Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy
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Kurahashi H, Okumura A, Kubota T, Kidokoro H, Maruyama K, Hayakawa M, Itakura A, Matsuzawa K, Yamamoto H, Kato T, Hayakawa F, Watanabe K. Increased fetal heart rate variability in periventricular leukomalacia. Brain Dev 2016; 38:196-203. [PMID: 26338690 DOI: 10.1016/j.braindev.2015.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/15/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study used quantitative analysis to determine whether increased variability in fetal heart rate (FHR) is related to the risk of developing periventricular leukomalacia (PVL). METHODS We analyzed 124 FHR traces of neonates delivered preterm at 27-33 weeks' gestation to 105 mothers. FHR traces 1-3h before delivery were translated into power-spectrum curves using a fast Fourier transformation. The total power (the area under the curve of 1-10 cycles per minute), segmental power of every cycle per minute, peak power, and frequency edges were calculated, and their relationship with the subsequent development of PVL was examined. RESULTS Total power was significantly higher in the PVL group (n=9, median 1813, range 1064-2426) compared to the non-PVL group (n=114, median 1383, range 381-3324, p=0.029). Infants in the PVL group had greater segmental power in segments with 1-2, 2-3, and 9-10 cycles per minute, than those in the non-PVL group. Total power of ⩾1550 was significantly correlated with the subsequent development of PVL and premature rupture of membranes. Furthermore, the frequency of pregnancy-induced hypertension was significantly reduced in the fetuses with a total power of ⩾1550. CONCLUSION Our study suggests that a fetus with increased FHR variability is at risk of developing PVL. This study provides additional evidence supporting the contribution of antenatal factors to the subsequent development of PVL.
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Affiliation(s)
- Hirokazu Kurahashi
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Pediatrics, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Koichi Maruyama
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Hayakawa
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Maternity and Perinatal Care Center, Nagoya University Hospital, Nagoya, Japan
| | - Atsuo Itakura
- Maternity and Perinatal Care Center, Nagoya University Hospital, Nagoya, Japan; Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Katsuji Matsuzawa
- Department of Gynecology and Obstetrics, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Kato
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Fumio Hayakawa
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Aichi, Japan
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Eventov-Friedman S, Shinwell ES, Barnea E, Flidel-Rimon O, Juster-Reicher A, Levy R. Correlation between fetal heart rate reactivity and mortality and severe neurological morbidity in extremely low birth weight infants. J Matern Fetal Neonatal Med 2011; 25:654-5. [PMID: 21780854 DOI: 10.3109/14767058.2011.591457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the correlation between specific fetal heart rate (FHR) abnormalities and the incidence of death, severe (grade 3-4) intraventricular hemorrhage (IVH) and periventricular echogenicity (PVE) in extremely low birth weight infants (ELBW) within the first 4 days after birth. METHODS The study included live-born ELBW infants ≤ 30 weeks' gestation who were born in 2000-2007 at Kaplan Medical Center, Rehovot, Israel, and, who had FHR monitoring during the 24 h before delivery and cranial ultrasound during the first 4 days of life. FHR pattern was analyzed for the presence of baseline rate, reactivity, variability and decelerations. RESULTS 96 infants with mean birth weight 757 ± 150 g and mean gestational age 25.8 ± 1.5 weeks were included. By 4 days of life, 23/96 (24%) died, 17/96 (18%) developed severe IVH and 31/96 (32%) had PVE. Absence of reactivity was significantly associated with increase in both death (p = 0.02, OR 3.45, 95% CI: 1.22-9.47 and severe IVH (p = 0.029, OR 3.33, 95% CI: 1.25-10) but not with PVE. Other FHR parameters were not associated with adverse outcome. CONCLUSION These results suggest that FHR reactivity may be of value in predicting short-term outcome in ELBW infants. This may be helpful in counseling parents with imminent extremely preterm birth.
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Affiliation(s)
- S Eventov-Friedman
- Department of Neonatology, Kaplan Medical Center, Rehovot and Hebrew University, Jerusalem, Israel
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Chen HY, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. Am J Obstet Gynecol 2011; 204:491.e1-10. [PMID: 21752753 DOI: 10.1016/j.ajog.2011.04.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/22/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. STUDY DESIGN We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. RESULTS In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores <4 at 5 minutes (relative risk, 0.54); in high-risk pregnancies, with decreased risk of neonatal seizures (relative risk, 0.65). CONCLUSION In the United States, the use of electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality.
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Fairchild KD, O'Shea TM. Heart rate characteristics: physiomarkers for detection of late-onset neonatal sepsis. Clin Perinatol 2010; 37:581-98. [PMID: 20813272 PMCID: PMC2933427 DOI: 10.1016/j.clp.2010.06.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Early detection of late-onset neonatal sepsis, before the onset of obvious and potentially catastrophic clinical signs, is an important goal in neonatal medicine. Sepsis causes a well-known series of physiologic changes including abnormalities of blood pressure, respiration, temperature, and heart rate, and less well-known changes in heart rate variability. Although vital signs are frequently or continuously monitored in patients in the neonatal intensive care unit (NICU), changes in these parameters are subtle in the early phase of sepsis and difficult to interpret using traditional NICU monitoring tools. A new tool, continuous monitoring of heart rate characteristics (HRC), is now available for clinical use. Recent research has established that 2 abnormalities of HRC that have long been used by obstetricians to identify fetal compromise, reduced heart rate variability and transient decelerations, occur early in the course of sepsis in patients in the NICU, often before clinical signs of illness. Through mathematical modeling of electrocardiogram data from hundreds of patients in the NICU, an HRC index that represents the fold increase in risk that a neonate will be diagnosed with clinical or culture-proven sepsis within the next 24 hours was derived. The effect of continuous HRC monitoring on outcomes in preterm very low birth weight infants is the subject of a multicenter randomized clinical trial of 3000 patients, which will be complete in 2010. Further research into mechanisms of abnormal HRC and regulation of autonomic nervous system function in sepsis and other disease processes will shed light on additional applications of this exciting new technology.
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Affiliation(s)
- Karen D. Fairchild
- Associate Professor of Pediatrics Division of Neonatology University of Virginia
| | - T. Michael O'Shea
- Professor of Pediatrics Chief, Division of Neonatology Wake Forest University
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[Cerebral palsy and perinatal asphyxia (I--diagnosis)]. ACTA ACUST UNITED AC 2010; 38:261-77. [PMID: 20378389 DOI: 10.1016/j.gyobfe.2010.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 02/12/2010] [Indexed: 11/23/2022]
Abstract
Cerebral palsy (CP) is a group of disorders of the development of movement and posture, causing activity limitations, that are attributed to nonprogressing disturbances that occurred in the developing fetal or infant brain. The motor abnormalies are often accompanied by disturbances of sensation, perception, cognition, behavior and/or by a seizure disorder. The prevalence of CP has not decreased in developed countries over the past 30 years, despite the widespread use of electronic fetal heart rate monitoring and a 5- to 6-fold increase in the cesarean delivery rate. In the term newborn, CP may be attributed to perinatal asphyxia in case of metabolic acidosis in the cord blood (pH<7,00 and base deficit>12 mmol/L), followed by a moderate or severe neonatal encephalopathy within 24 hours and a further neurological impairement characterized by spastic quadriplegia and dyskinesia/dystonia. Dating the time of fetal asphyxia during delivery is possible when there are acute catastrophic complications during labor and unexpected acute or progressive fetal heart rate anomalies after a normal admission test, when there is a need for intensive neonatal resuscitation, a multi-organ failure within 72 hours of birth and visualization of acute non focal cerebral abnormalities, mainly by early magnetic resonance imaging (MRI). MRI sequences show either a brain-damaged pattern of the central basal ganglia, thalami and posterior limbs of internal capsules with relative cortical sparing, in acute, near-total asphyxial insults manifested by a continuous bradycardia or a pattern of cortical injury in the watershed zones and relative sparing of the central grey matter, in prolonged partial asphyxia, manifested by late or atypical variable decelerations with progressive fetal tachycardia, loss of reactivity and absent fluctuation. Prolongation of either type of asphyxial insult results in more global brain damage. In order to differentiate a CP occurring after perinatal asphyxia from other neurological sequelae in relation with infection, hemorrhage, stroke, malformations, genetic or metabolic diseases, it is essential that a definitive information from the brain by MRI and an extensive histological examination of the placenta are at disposal.
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Affiliation(s)
- Diana E Schendel
- National Center on Birth Defects & Developmental Disabilities, Centers for Disease Control & Prevention, 1600 Clifton Road, MS E-86, Atlanta, GA 30333, USA
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Blad S, Welin AK, Kjellmer I, Rosén K, Mallard C. ECG and Heart Rate Variability Changes in Preterm and Near-Term Fetal Lamb Following LPS Exposure. Reprod Sci 2008; 15:572-83. [DOI: 10.1177/1933719107314060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sofia Blad
- Perinatal Center, Department of Neuroscience and Physiology,
| | | | - Ingemar Kjellmer
- Pediatrics, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Carina Mallard
- Perinatal Center, Department of Neuroscience and Physiology
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Rosier-van Dunné FM, van Geijn HP, Odendaal HJ, van Wezel-Meijler G, De Vries JI. Fetal brain sonography and fetal heart rate patterns in the preterm fetus. Am J Obstet Gynecol 2008; 198:296.e1-6. [PMID: 18221933 DOI: 10.1016/j.ajog.2007.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 06/17/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to study whether peri- and intraventricular echodensities in the brain of fetuses at risk for preterm birth are associated with changes in fetal heart rate (FHR) parameters. STUDY DESIGN Twenty preterm fetuses with peri- and intraventricular echodensities detected by transvaginal ultrasonography were matched with 20 fetuses without echodensities for gestational age, growth parameters, clinical disease, and maternal medication. Baseline FHR, long- and short-term variability, and the presence of accelerations and decelerations were analyzed with a computerized system and compared with the Wilcoxon matched-pairs signed-rank test. Both cases and controls were compared with a normal population. RESULTS No statistical differences in FHR parameters were found between cases with and controls without peri- and intraventricular echodensities. Both cases and controls had lower long- and short-term variabilities than the normal population. CONCLUSION No association between the presence of peri- and intraventricular echodensities and specific FHR changes was demonstrated.
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Larma JD, Silva AM, Holcroft CJ, Thompson RE, Donohue PK, Graham EM. Intrapartum electronic fetal heart rate monitoring and the identification of metabolic acidosis and hypoxic-ischemic encephalopathy. Am J Obstet Gynecol 2007; 197:301.e1-8. [PMID: 17826429 DOI: 10.1016/j.ajog.2007.06.053] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 05/21/2007] [Accepted: 06/27/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether electronic fetal monitoring can identify fetuses with metabolic acidosis and hypoxic-ischemic encephalopathy. STUDY DESIGN The cases were 107 nonanomalous chromosomally normal fetuses with an umbilical arterial pH < 7.0 and base excess < or = 12 mmol/L. Controls were the subsequent delivery that was matched by gestational age and mode of delivery. The last hour of electronic fetal monitoring before delivery was evaluated by 3 obstetricians who were blinded to outcome. RESULTS Cases had a significant increase in late and prolonged decelerations/hour and late decelerations/contractions. Those fetuses with hypoxic-ischemic encephalopathy had significant increases in bradycardia, decreased variability, and nonreactivity but no difference in late or variable decelerations/hour. For the identification of hypoxic-ischemic encephalopathy, the sensitivity, specificity, and positive and negative predictive values were 15.4%, 98.9%, 66.7%, and 89.4%, respectively, for bradycardia; 53.8%, 79.8%, 26.9%, and 92.6%, respectively, for decreased variability; 92.3%, 61.7%, 2.7%, and 82.9%, respectively, for nonreactivity; and 7.7%, 98.9%, 50.0%, and 88.6%, respectively, for all 3 abnormalities combined. CONCLUSION Fetal metabolic acidosis and hypoxic-ischemic encephalopathy are associated with significant increases in electronic fetal monitoring abnormalities, but their predictive ability to identify these conditions is low.
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Affiliation(s)
- Joel D Larma
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
The literature on intrapartum fetal monitoring is reviewed emphasizing the pathophysiology, and current practice guidelines are discussed. FHR monitoring, ancillary tests, and investigational modalities are considered.
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Affiliation(s)
- Nadav Schwartz
- New York University Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York, NY 10016, USA
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Graham EM, Petersen SM, Christo DK, Fox HE. Intrapartum Electronic Fetal Heart Rate Monitoring and the Prevention of Perinatal Brain Injury. Obstet Gynecol 2006; 108:656-66. [PMID: 16946228 DOI: 10.1097/01.aog.0000230533.62760.ef] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Electronic fetal heart rate monitoring (EFM) is the most widely used method of intrapartum surveillance, and our objective is to review its ability to prevent perinatal brain injury and death. DATA SOURCES Studies that quantified intrapartum EFM and its relation to specific neurologic outcomes (seizures, periventricular leukomalacia, cerebral palsy, death) were eligible for inclusion. MEDLINE was searched from 1966 to 2006 for studies that examined the relationship between intrapartum EFM and perinatal brain injury using these MeSH and text words: "cardiotocography," "electronic fetal monitoring," "intrapartum fetal heart rate monitoring," "intrapartum fetal monitoring," and "fetal heart rate monitoring." METHODS OF STUDY SELECTION This search strategy identified 1,628 articles, and 41 were selected for further review. Articles were excluded for the following reasons: in case reports, letters, commentaries, and review articles, intrapartum EFM was not quantified, or specific perinatal neurologic morbidity was not measured. Three observational studies and a 2001 meta-analysis of 13 randomized controlled trials were selected for determination of the effect of intrapartum EFM on perinatal brain injury. TABULATION, INTEGRATION, AND RESULTS Electronic fetal monitoring was introduced into widespread clinical practice in the late 1960s based on retrospective studies comparing its use to historical controls where auscultation was performed in a nonstandardized manner. Case-control studies have shown correlation of EFM abnormalities with umbilical artery base excess, but EFM was not able to identify cerebral white matter injury or cerebral palsy. Of 13 randomized controlled trials, one showed a significant decrease in perinatal mortality with EFM compared with auscultation. Meta-analysis of the randomized controlled trials comparing EFM with auscultation have found an increased incidence of cesarean delivery and decreased neonatal seizures but no effect on the incidence of cerebral palsy or perinatal death. CONCLUSION Although intrapartum EFM abnormalities correlate with umbilical cord base excess and its use is associated with decreased neonatal seizures, it has no effect on perinatal mortality or pediatric neurologic morbidity.
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Affiliation(s)
- Ernest M Graham
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287-1228, USA
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Abstract
PURPOSE OF REVIEW The principles of neonatal neurological protection following intrapartum hypoxia are briefly reviewed. The physiological principles behind the use of cardiotocograph patterns in defining the timing and mechanism of fetal hypoxia and injury are then demonstrated. RECENT FINDINGS Fetal neurological injury may result from progressive hypoxemia, acidosis, diminished cardiac output and cerebral ischemia, manifested at birth as low Apgar scores, multisystem compromise, severe acidosis and encephalopathy. More commonly, however, intrapartum injury results from often intermittent, regional ischemia secondary to umbilical cord or head compression resulting in hemorrhage or infarction. Under these circumstances, the amount of umbilical acidosis and neonatal encephalopathy varies and the potential candidate for neuroprotection may escape recognition and timely treatment. Selecting infants likely to benefit from neuroprotection requires information on the timing, duration and mechanism of hypoxia. Neonatal parameters, including low Apgar scores, acidosis, even seizures, lack sensitivity and specificity. Cardiotocograph patterns are capable of determining the duration, mechanism and severity of hypoxia and occasionally, the timing of neurological injury. SUMMARY Protecting the newborn from the neurological consequences of intrapartum hypoxia requires critical definition of the mechanism and timing of this exposure. cardiotocograph tracings offer the opportunity to refine the selection of candidates for neonatal rescue.
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Affiliation(s)
- Barry S Schifrin
- Loma Linda University School of Medicine, Loma Linda, California, USA
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