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Published on: September 6, 2017
Can electronic fetal monitoring identify preterm neonates with cerebral white matter injury?
Janyne E Althaus1, Scott M Petersen, Harold E Fox
1Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. jalthau1@jhmi.edu
Insights
Electronic fetal monitoring cannot identify preterm infants with brain injury. Despite some associations with acidosis, standard electronic monitoring failed to detect cerebral white matter injury in neonates.
Area of Science:
- Neonatal neurology
- Perinatal medicine
- Fetal monitoring
Background:
- Preterm delivery affects 10% of births, with high risk for cerebral white matter injury.
- Infants with cerebral white matter injury account for one-third of cerebral palsy cases.
- Identifying at-risk fetuses is crucial for early intervention.
Purpose of the Study:
- To determine if electronic fetal monitoring can identify preterm fetuses with neonatal brain injury.
- To assess the predictive value of fetal heart rate patterns for cerebral white matter injury.
Main Methods:
- A case-control study matched 150 neonates with diagnosed cerebral white matter injury to 150 controls by gestational age.
- Fetal monitoring tracings were reviewed by blinded perinatologists.
- Vaginal and cesarean deliveries were analyzed separately.
Main Results:
- No significant differences in heart rate patterns (baseline, variability, decelerations) were found between cases and controls.
- A specific pattern (amplitude range < 5 bpm) showed low predictive value for severe metabolic acidosis.
- Late decelerations correlated with lower umbilical arterial pH but were not significantly different between groups.
Conclusions:
- Electronic fetal monitoring is currently unable to identify preterm neonates with cerebral white matter injury.
- While some patterns correlate with acidosis, they lack sufficient predictive power for brain injury.
Objective:
Although preterm delivery occurs in only 10% of all births, these infants are at high risk for cerebral white matter injury and constitute a third of all cerebral palsy cases. Our objective was to estimate if electronic monitoring can identify preterm fetuses diagnosed with brain injury during the neonatal period.
Methods:
In this case-control study, 150 consecutive neonates with ultrasonography-diagnosed cerebral white matter injury were matched by gestational age within 7 days to 150 controls with normal head ultrasonograms. Tracings were retrieved for 125 cases (83%) and 121 controls (81%) and reviewed by 3 perinatologists blinded to outcome. Vaginal (64 cases, 72 controls) and cesarean deliveries (61 cases, 49 controls) were analyzed separately.
Results:
There was no difference in baseline heart rate, tachycardia, bradycardia, short-term variability, accelerations, reactivity, number or types of decelerations, or bradycardic episodes between cases and controls in either the vaginal or cesarean delivery groups. For the 6 neonates with metabolic acidosis severe enough to increase the risk for long-term neurologic morbidity, there was a significant increase in baseline amplitude range less than 5 beats per minute; however, its positive predictive value in predicting severe metabolic acidosis was only 7.7%. Increasing late decelerations were associated with decreasing umbilical arterial pH and base excess, but were not significantly different in the acidosis and control groups (1.0 +/- 1.8, 0.55 +/- 1.23 late decelerations per hour, P = .39).
Conclusion:
Although decreased short-term variability and increased late decelerations are associated with decreasing umbilical arterial pH and base excess, electronic fetal monitoring is unable to identify preterm neonates with cerebral white matter injury.
