Related Experiment Videos
Clustering of perinatal markers of birth asphyxia and outcome at age five years
P L Yudkin1, A Johnson, L M Clover
1Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK.
Insights
Birth asphyxia, indicated by serious neonatal encephalopathy, leads to poor neurodevelopmental outcomes. However, abnormal fetal heart rate patterns or acid-base issues without encephalopathy do not predict later impairment in term infants.
Area of Science:
- Perinatal Medicine
- Neonatology
- Developmental Pediatrics
Background:
- Investigating the long-term neurodevelopmental effects of birth asphyxia in term infants is crucial.
- Understanding the predictive value of specific perinatal indicators for adverse outcomes is essential for clinical practice.
Observation:
- A cohort of 184 term infants with cerebral depression at birth (1-minute Apgar score ≤3) was followed for five years.
- Seven infants exhibited a cluster of perinatal signs suggestive of birth asphyxia, all with serious neonatal encephalopathy.
- The remaining infants showed no association between abnormal fetal heart rate patterns or acid-base status and neurodevelopmental test scores.
Findings:
- Birth asphyxia, identified by a cluster of abnormal perinatal signs including serious neonatal encephalopathy, is associated with a poor prognosis.
- Among infants with cerebral depression at birth, serious neonatal encephalopathy was a key indicator of adverse neurodevelopmental outcomes.
- The presence of abnormal fetal heart rate patterns or acid-base derangement alone, without serious neonatal encephalopathy, did not predict later neurodevelopmental impairment.
Implications:
- Early identification of serious neonatal encephalopathy is critical for predicting long-term neurodevelopmental outcomes in infants experiencing birth asphyxia.
- Clinical management and prognostication should focus on the presence and severity of neonatal encephalopathy rather than isolated perinatal events.
- Further research may refine the understanding of subtle indicators of birth asphyxia and their impact on neurodevelopment.
Objectives:
In a cohort of term infants with cerebral depression at delivery, to investigate the association of perinatal signs of birth asphyxia, particularly abnormal fetal heart rate patterns in labour, acidaemia, and serious neonatal encephalopathy, with neurodevelopmental outcome at age five years.
Design:
Five year follow up study of a birth cohort.
Setting:
Regional maternity hospital.
Subjects:
One hundred and eighty-four singleton infants with a 1 min Apgar score < or = 3, born at term between January 1984 and September 1985.
Main Outcome Measures:
Neonatal death, cerebral palsy, and scores on a battery of neurodevelopmental tests at age five.
Results:
Seven infants had a cluster of perinatal signs suggestive of birth asphyxia; all included serious neonatal encephalopathy. Three of these infants died neonatally, three had spastic quadriparesis with profound developmental delay, and one was unimpaired at the age of five. Among the remaining infants, no association was found between severely abnormal fetal heart rate patterns in labour and scores on neurodevelopmental tests, or between acid-base status at delivery and test scores.
Conclusions:
Birth asphyxia, identified by a cluster of abnormal perinatal signs, including serious neonatal encephalopathy, has a poor prognosis. If serious encephalopathy is not present, cerebral depression at birth preceded by abnormal fetal heart rate patterns in labour, or with acid-base derangement, is not predictive of later impairment.