Intrapartum fetal heart rate patterns preceding terminal bradycardia in infants (&gt;34 weeks) with poor neurological outcome: A regional population‐based study in Japan

Kodama, Yasuo; Sameshima, Hiroshi; Yamashita, Rie; Oohashi, Masanao; Ikenoue, Tsuyomu

doi:10.1111/jog.12797

Cited by 6 publications

(17 citation statements)

References 24 publications

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“…21 Two give fuller details but are too small to allow robust conclusions. 20,35 Bearing these limitations in mind, the observational reports were reasonably consistent. A sentinel event and/or persistent bradycardia lasting less than 10 minutes was not usually associated with long-term injury.…”

Section: Discussionmentioning

confidence: 99%

“…As well as being observational and non‐population based, most are retrospective and lack important details, such as the depth of the bradycardias, the type and severity of CP, how CP and other outcomes were assessed, the duration of follow‐up, or neuroimaging findings. Some give times that appear to be rounded to the nearest 5 minutes . One paper reports abnormal outcomes after fetal bradycardias of 80 beats/minute or less, lasting 1 to 12 hours, but few others report survival after this duration .…”

Section: Discussionmentioning

confidence: 99%

“…Observational data that include duration were obtained from repeated literature searches on outcomes after sentinel events and fetal monitoring. It is summarized in Table S1 (online supporting information), divided into sentinel events, acute persistent fetal bradycardia associated with unknown, unspecified, or mixed causes in term born infants, the same in those where gestation was either not specified or mixed, other or mixed FHR abnormalities, pure MRI data, and specific preterm data …”

Section: Outcome With Reported Individual Duration Data After Persistmentioning

confidence: 99%

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Markers of perinatal hypoxia–ischaemia and neurological injury: assessing the impact of insult duration

Baxter

2019

Develop Med Child Neuro

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Hypoxic–ischaemic insults occurring during or after birth can cause both acute and long‐term neurological impairment. The duration of the insult is a critical factor, but most published reports of duration have important limitations. After the onset of a persistent bradycardia in 125 term born infants, abnormal outcomes occurred in two by 10 minutes, in 12 out of 47 (26%) delivered between 11 and 20 minutes, and in 55 out of 65 (85%) delivered after 20 minutes. Series with unspecified gestation or including infants born preterm give comparable results in over 500 additional cases. Before 20 minutes there was little correlation with severity, while after 20 minutes most were severely impaired. Limited neuroimaging data suggest that damage restricted to the basal ganglia and thalamus may begin to occur after 10 minutes, associated Rolandic damage after 15 minutes, and other cortical involvement after 20 minutes. Associated white matter damage can occur after any duration. There were little data for other patterns of damage. What this paper adds Some term born infants can withstand 20 minutes of fetal bradycardia without acute or chronic damage. Durations in humans are not the same as in animal models.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Outcome With Reported Individual Duration Data After Persistmentioning

confidence: 99%

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Markers of perinatal hypoxia–ischaemia and neurological injury: assessing the impact of insult duration

Baxter

2019

Develop Med Child Neuro

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“…The best-documented arrhythmia during PA is sinus bradycardia, with a cut-off value of 80 beats per minute (14,67). Below this value, the evolution is unfavorable, sometimes leading to terminal bradycardia (68,69). Moreover, bradycardia lasting more than 13 min correlates with the development of cerebral palsy (68).…”

Section: Arrhythmiasmentioning

confidence: 99%

“…Below this value, the evolution is unfavorable, sometimes leading to terminal bradycardia (68,69). Moreover, bradycardia lasting more than 13 min correlates with the development of cerebral palsy (68). Also, bradycardia is a critical time marker for delivery, as more than 18 min from uterine rupture until delivery leads to substantial morbidity (70).…”

Section: Arrhythmiasmentioning

confidence: 99%

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

et al. 2020

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Perinatal asphyxia (PA) is a burdening pathology with high short-term mortality and severe long-term consequences. Its incidence, reaching as high as 10 cases per 1000 live births in the less developed countries, prompts the need for better awareness and prevention of cases at risk, together with management by easily applicable protocols. PA acts first and foremost on the nervous tissue, but also on the heart, by hypoxia and subsequent ischemia-reperfusion injury. Myocardial development at birth is still incomplete and cannot adequately respond to this aggression. Cardiac dysfunction, including low ventricular output, bradycardia, and pulmonary hypertension, complicates the already compromised circulatory status of the newborn with PA. Multiorgan and especially cardiovascular failure seem to play a crucial role in the secondary phase of hypoxic-ischemic encephalopathy (HIE) and its high mortality rate. Hypothermia is an acceptable solution for HIE, but there is a fragile equilibrium between therapeutic gain and cardiovascular instability. A profound understanding of the underlying mechanisms of the nervous and cardiovascular systems and a close collaboration between the bench and bedside specialists in these domains is compulsory. More resources need to be directed toward the prevention of PA and the consecutive decrease of cardiovascular dysfunction. Not much can be done in case of an unexpected acute event that produces PA, where recognition and prompt delivery are the key factors for a positive clinical result. However, the situation is different for high-risk pregnancies or circumstances that make the fetus more vulnerable to asphyxia. Improving the outcome in these cases is possible through careful monitoring, identifying the high-risk pregnancies, and the implementation of novel prenatal strategies. Also, apart from adequately supporting the heart through the acute episode, there is a need for protocols for long-term cardiovascular follow-up. This will increase our recognition of any lasting myocardial damage and will enhance our perspective on the real impact of PA. The goal of this article is to review data on the cardiovascular consequences of PA, in the context of an immature cardiovascular system, discuss the potential contribution of cardiovascular impairment on short and long-term outcomes, and propose further directions of research in this field.

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Medicolegal Aspects of Neurological Disorders in Pregnancy, the Fetus, and the Newborn

Jumah,

Rallo,

Sreenivasan

et al. 2023

Neurological Disorders in Pregnancy

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Intrapartum fetal heart rate patterns preceding terminal bradycardia in infants (>34 weeks) with poor neurological outcome: A regional population‐based study in Japan

Cited by 6 publications

References 24 publications

Markers of perinatal hypoxia–ischaemia and neurological injury: assessing the impact of insult duration

Markers of perinatal hypoxia–ischaemia and neurological injury: assessing the impact of insult duration

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

Medicolegal Aspects of Neurological Disorders in Pregnancy, the Fetus, and the Newborn

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