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Published on: November 20, 2015
Incidence of encephalopathy and comorbidity in infants with perinatal asphyxia: a comparative prospective cohort
Cristina Vega-Del-Val1, Juan Arnaez1,2,3, Carlos Ochoa-Sangrador4,5
1Neonatology Unit, Hospital Universitario de Burgos, Burgos, Spain.
Insights
A cord arterial pH of 7.00 or less is a critical indicator for monitoring neonates for hypoxic-ischemic encephalopathy (HIE). Early detection of HIE in newborns with perinatal asphyxia is crucial for timely intervention and improved outcomes.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Neurology
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a serious condition in newborns resulting from perinatal asphyxia.
- Effective detection programs require identifying neonates needing monitoring within the first 6 hours of life.
- Establishing clear diagnostic criteria is essential for timely HIE management.
Purpose of the Study:
- To determine the optimal arterial cord pH threshold for identifying neonates at risk of moderate-to-severe hypoxic-ischemic encephalopathy (HIE).
- To evaluate the association between cord arterial pH values and neonatal comorbidities, including HIE.
- To inform the development of monitoring protocols for newborns with suspected perinatal asphyxia.
Main Methods:
- An observational prospective cohort study included infants with gestational age ≥35 weeks and weight >1,800g.
- Infants were categorized based on arterial cord pH (ApH): ≤7.00 versus 7.01-7.10.
- Data collected included obstetrical history, neonatal comorbidities (including HIE within 6 hours of life), and neurological exams at discharge.
Main Results:
- All 9 cases of moderate-to-severe HIE occurred in infants with an ApH ≤7.00.
- Infants with ApH ≤7.00 had significantly higher odds of abnormal neurological exam or death at discharge (OR 12.03).
- The ApH ≤7.00 group required more ventilation support (5.1 times) and experienced higher rates of hypoglycemia (37% vs. 25%).
Conclusions:
- An arterial cord pH of 7.00 serves as a potential safe cut-off for developing monitoring protocols for acidemic neonates.
- This threshold aids in the early identification of infants with moderate or severe HIE.
- While the ApH ≤7.00 cohort shows significant comorbidity, the ApH 7.01-7.10 cohort also presents non-negligible risks.
Background:
Programs that aim to improve the detection hypoxic-ischemic encephalopathy (HIE) should establish which neonates suffering from perinatal asphyxia need to be monitored within the first 6 h of life.
Method:
An observational prospective cohort study of infants with gestational age ≥35 weeks, and above 1,800g, were included according to their arterial cord pH value (ApH): ≤7.00 vs. 7.01-7.10. Data was collected including obstetrical history, as well as neonatal comorbidities, including the presence of HIE, that happened within 6 h of life. A standardized neurological exam was performed at discharge.
Results:
There were 9,537 births; 176 infants with ApH 7.01-7.10 and 117 infants with ApH ≤7.00. All 9 cases with moderate-to-severe HIE occurred among infants with ApH ≤7.00. The incidence of global and moderate-severe HIE was 3/1,000 and 1/1,000 births, respectively. Outcome at discharge (abnormal exam or death) showed an OR 12.03 (95% CI 1.53, 94.96) in infants with ApH ≤7.00 compared to ApH 7.01-7.10 cohort. Ventilation support was 5.1 times (95% CI 2.87, 9.03) more likely to be needed by those with cord ApH ≤7.00 compared to those with ApH 7.01-7.10, as well as hypoglycemia (37% vs. 25%; p = 0.026). In 55%, hypoglycemia occurred despite oral and/or intravenous glucose administration had been already initiated.
Conclusions:
Cord pH 7.00 might be a safe pH cut-off point when developing protocols to monitor infants born with acidemia in order to identify infants with moderate or severe HIE early on. There is non-negligible comorbidity in the ApH ≤7.00 cohort, but also in the 7.01-7.10 cohort.
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