Perinatal maternal characteristics predict a high risk of neonatal asphyxia: A multi-center retrospective cohort study in China

Abstract

ObjectiveThis study aimed to identify various perinatal maternal characteristics that contributed to neonatal asphyxia (NA) in term and late-preterm newborns based on the data obtained from a Chinese birth registry cohort and to establish an effective model for predicting a high risk of asphyxia.MethodWe retrospectively reviewed and analyzed the birth database from July 1, 2016, to June 30, 2017, in the main economically developed regions of China. Asphyxia was defined as an Apgar score <7 at 5 min post-delivery with umbilical cord arterial blood pH < 7.2 in the infant born after 34weeks. We compared the perinatal maternal characteristics of the newborns who developed asphyxia (NA group, n = 1,152) and those who did not (no NA group, n = 86,393). Candidate predictors of NA were analyzed using multivariable logistic regression. Subsequently, a prediction model was developed and validated by an independent test group.ResultOf the maternal characteristics, duration of PROM ≥ 48 h, a gestational week at birth <37, prolonged duration of labor, hypertensive disorder, nuchal cord, and birth weight <2,500 or ≥4,000 g, abnormal fetal heart rate, meconium-stained amniotic fluid, and placenta previa were included in the predicting model, which presented a good performance in external validation (c-statistic of 0.731).ConclusionOur model relied heavily on clinical predictors that may be determined before or during birth, and pregnant women at high risk of NA might be recognized earlier in pregnancy and childbirth using this methodology, allowing them to avoid being neglected and delayed. Future studies should be conducted to assess its usefulness.

Correlation analysis between the amniotic fluid contamination and clinical grading of neonatal hypoxic–ischemic encephalopathy and biomarkers of brain damage

“…The AFC level can be divided into three levels: I°AFC, II°AFC, and III°AFC (also known as MSAF). There have been many reports regarding AFC in neonatal asphyxia; the incidence of AFC in neonatal asphyxia was 11.5–56.1% [ 8 , 9 ], and severe neonatal asphyxia may be involved in multiple organ damage, such as neonatal HIE, respiratory distress syndrome, neonatal necrotizing enterocolitis, renal and liver damage. Among these adverse consequences, neonatal HIE was of the greatest concern to obstetricians and neonatologists.…”

“…Many factors can alter the characteristics of amniotic fluid, leading to amniotic fluid contamination (AFC). The incidence of AFC in neonatal HIE was reported to be 47.3% [ 5 ], and the incidence of MSAF in neonatal asphyxia was 11.5–56.1% [ 8 , 9 ]. To date, there are few reports on the assessment of different AFC levels and the incidence of HIE, clinical grading of HIE, and biomarkers of brain damage.…”

Relationship of Nucleated Red Blood Cells with Severity of Perinatal Asphyxia and its Short-Term Outcome

“…The severe neonatal asphyxia can damage various organs, such as the brain, the heart, the lungs, necrotizing enterocolitis, the kidneys and the hepatic incompetence; it can even put the survival of a newborn at risk. 13 It has been observed that the raised NRBCs in the blood of umbilical cord could be a helpful indicator of birth asphyxia. 14 In this study 112 newborns were studied, to assess the association of NRBC with perinatal hypoxia and we found average of NRBCs was seen significantly high in cases 16.62+17.10 as compared to control group as 1.69+2.42 (p=0.0001) along with the average of neonatal NRBs was significantly associated to severity of perinatal hypoxia (p-0.0001).…”

“…All the babies admitted after 24 hours of delivery, those having any other risk factor (Cyanotic heart disease, intrauterine growth restriction, Hemolytic disease of new born, Post term babies) or patients having any dysmorphism assessed on history and medical records were excluded. The severity of birth asphyxia was categorized as mild (1-10), moderate (11)(12)(13)(14), and severe (15) according to the Thompson scoring of hypoxic ischemic encephalopathy. 12 A detailed history was taken, and important aspects were noted, like the mode of delivery, place of delivery, history of crying at the time of delivery, history of prolong or obstructed labor, history of antenatal steroids, gestational age, history of leaking, vaginal discharge, and fever in the perinatal period.…”

Labor management and neonatal outcomes in cardiotocography categories II and III (Review)

“…While research has shown a positive effect on fetal oxygenation from certain intrauterine resuscitation techniques, no evidence is yet available to indicate that they are capable of reversing fetal hypoxemia (27)(28)(29)(30)(31).…”