Antenatal antecedents of moderate or severe neonatal encephalopathy in term infants – a regional review

West, Claire; Curr, Liz; Battin, Malcolm; Harding, Jane E.; McCowan, Lesley; Belgrave, Sue; Knight, David B.; Westgate, Jenny A.

doi:10.1111/j.1479-828x.2005.00390.x

Cited by 31 publications

(20 citation statements)

References 18 publications

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“…Recent cohort studies involving expert examination of the fetal heart rate recordings of infants with moderate to severe encephalopathy, plus metabolic acidosis on cord blood, suggest, however, that just 15-25% had abnormal recordings in early labor that might indicate antenatal hypoxia [21,22]. The remainder either had had catastrophic events (approximately 25%) or had evidence of evolving 'nonreassuring' heart rate patterns.…”

Section: Clinical Evidence For Timing Of Injury At Termmentioning

confidence: 93%

Timing of injury in the fetus and neonate

Gunn¹

2008

Current Opinion in Obstetrics and Gynecology

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Section: Clinical Evidence For Timing Of Injury At Termmentioning

confidence: 93%

Timing of injury in the fetus and neonate

Gunn¹

2008

Current Opinion in Obstetrics and Gynecology

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“…10 In a regional study of moderate or severe NE in term infants, 17% were SGA. 6 SGA has consistently been associated with risk of CP. [33][34][35] Genetic, infectious, and nutritional factors can contribute to growth restriction, and defective placentation and disorders of the placenta also seem to be major factors.…”

Section: Fetal Growth Restrictionmentioning

confidence: 97%

“…Similarly, sentinel events were identified in a fairly small minority of infants with NE in controlled studies in representative populations: 7.9% 5 and 25%. 6 In a referral sample of 500 term infants with NE evaluated for therapeutic hypothermia, 48 (9%) had had a sentinel birth event. 22 Fetal bradycardia (its onset, severity, and duration unspecified) was recognized in 34% of infants.…”

Section: Acute Asphyxial Indicatorsmentioning

confidence: 99%

“…Controlled studies of antecedents of NE in representative populations have found that most infants who have NE did not have recognized asphyxial birth events, however. [4][5][6][7][8][9] Such studies and others related to them 4,10,11 have identified some additional unsuspected risk factors, pointing to a broader set of causal factors than previously recognized. Still, known risk factors for NE, singly or together, do not account for most cases of NE.…”

mentioning

confidence: 93%

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Antecedents of Neonatal Encephalopathy in the Vermont Oxford Network Encephalopathy Registry

et al. 2012

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“…[6][7][8] Several epidemiologic studies have identified adverse sociodemographic factors, maternal conditions, and antenatal complications in association with NE, and these data have focused attention on the antenatal period as the origin of HIE. [9][10][11][12] However, these studies have used inclusion criteria and definitions of encephalopathy that do not limit the study cohorts to infants likely to have HIE, and the role of many antepartum and intrapartum factors in the causal pathway of neonatal HIE remains unclear.…”

mentioning

confidence: 99%

Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Etiology and timing of onset of neonatal hypoxic-ischemic encephalopathy continue to be controversial. Previous studies suggest antepartum events are the main contributing factors, but have used a broad definition of encephalopathy and included infants with genetic, congenital, and developmental abnormalities.WHAT THIS STUDY ADDS: Our study suggests that when strict criteria defining hypoxic-ischemic encephalopathy are applied with supporting neuroimaging evidence of an acute hypoxicischemic insult, intrapartum events are the final and necessary pathway leading to this condition. abstract OBJECTIVE: To determine whether antepartum factors alone, intrapartum factors alone, or both in combination, are associated with term neonatal hypoxic-ischemic encephalopathy (HIE). METHODS:A total of 405 infants $35 weeks' gestation with early encephalopathy, born between 1992 and 2007, were compared with 239 neurologically normal infants born between 1996 and 1997. All cases met criteria for perinatal asphyxia, had neuroimaging findings consistent with acute hypoxia-ischemia, and had no evidence for a non-hypoxic-ischemic cause of their encephalopathy.RESULTS: Both antepartum and intrapartum factors were associated with the development of HIE on univariate analysis. Case infants were more often delivered by emergency cesarean delivery (CD; 50% vs 11%, P , .001) and none was delivered by elective CD (vs 10% of controls). On logistic regression analysis only 1 antepartum factor (gestation $41 weeks) and 7 intrapartum factors (prolonged membrane rupture, abnormal cardiotocography, thick meconium, sentinel event, shoulder dystocia, tight nuchal cord, failed vacuum) remained independently associated with HIE (area under the curve 0.88; confidence interval 0.85-0.91; P , .001). Overall, 6.7% of cases and 43.5% of controls had only antepartum factors; 20% of cases and 5.8% of controls had only intrapartum factors; 69.5% of cases and 31% of controls had antepartum and intrapartum factors; and 3.7% of cases and 19.7% of controls had no identifiable risk factors (P , .001). CONCLUSIONS:Our results do not support the hypothesis that HIE is attributable to antepartum factors alone, but they strongly point to the intrapartum period as the necessary factor in the development of this condition. Pediatrics 2013;132:e952-e959

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Antenatal antecedents of moderate or severe neonatal encephalopathy in term infants – a regional review

Abstract: Background: Regional audits of term infants with neonatal encephalopathy (NE) provide an opportunity to examine issues related to causation and quality of care.

Cited by 31 publications

References 18 publications

Timing of injury in the fetus and neonate

Timing of injury in the fetus and neonate

Antecedents of Neonatal Encephalopathy in the Vermont Oxford Network Encephalopathy Registry

Antepartum and Intrapartum Factors Preceding Neonatal Hypoxic-Ischemic Encephalopathy

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