Abstract
Introduction
Neonatal hypoxic-ischemic encephalopathy (HIE) is associated with neonatal mortality,
acute neurological injury, and long-term neurodevelopmental disabilities; however,
the association between intrapartum factors and HIE remains unclear.
Methods
This population-based cohort study used linked obstetrical and newborn data derived
from the Nova Scotia Atlee Perinatal Database (NSAPD, 1988–2015) and the AC Allen
Perinatal Follow-Up Program Database (2006–2015) for all pregnancies with live, non-anomalous
newborns ≥35 weeks gestation, not delivered by pre-labour cesarean section. Temporal
trends in HIE incidence were described, and logistic regression estimated odds ratios
(OR) with 95% confidence intervals (CI) for the association of intrapartum factors
with HIE.
Results
The NSAPD identified 227 HIE cases in the population of 226 711 deliveries from 1988
to 2015. Women with clinical chorioamnionitis in labour (OR 8.0; 95% CI 3.9–16), emergency
cesarean delivery (OR 10; 95% CI 7.6–14), shoulder dystocia (OR 3.5; 95% CI 2.1–5.7),
placental abruption (OR 18; 95% CI 11–29), and cord prolapse (OR 30; 95% CI 15–61)
were more likely to have newborns with HIE. Two-thirds of newborns with HIE had an
abnormal intrapartum fetal heart rate tracing. The mortality rate among infants with
HIE was 27% by 3 years of age. Neurodevelopmental outcomes in the surviving infants
were normal in 43% and showed severe developmental delay in 40%.
Conclusion
Overall, the rate of HIE was low in infants born at ≥35 weeks gestation. The identification
of associated intrapartum factors should promote increased surveillance in these clinical
situations and emphasize the importance of careful management to optimize newborn
outcomes.
Résumé
Introduction
L'encéphalopathie hypoxique-ischémique (EHI) est associée à la mortalité néonatale,
à l'atteinte neurologique aiguë et aux invalidités neurodéveloppementales à long terme;
cependant, l'association entre les facteurs intrapartum et l'EHI demeure incertaine.
Méthodologie
Dans cette étude de cohorte en population, les chercheurs ont utilisé les données
obstétricales et néonatales liées extraites de la base de données NSAPD (Nova Scotia
Atlee Perinatal Database; 1988–2015) et de la base de données du programme de suivi
périnatal d'AC Allen (2006–2015) pour toutes les grossesses qui se sont terminées
par la naissance à ≥ 35 SA d'un nouveau-né vivant sans anomalie au terme d'un accouchement
autre qu'une césarienne sans travail. L’étude décrit les tendances temporelles de
la fréquence de l'EHI et estime les rapports de cotes (RC) par régression logistique
avec un intervalle de confiance (IC) à 95 % pour l'association de facteurs intrapartum
avec l'EHI.
Résultats
La NSAPD a permis de relever 227 cas d'EHI dans une population de 226 711 accouchements
dans la période de 1988 à 2015. Les femmes qui ont subi une chorioamnionite clinique
pendant le travail (RC : 8,0; IC à 95 % : 3,9–16), une césarienne d'urgence (RC :
10; IC à 95 % : 7,6–14), une dystocie de l’épaule (RC : 3,5; IC à 95 % : 2,1–5,7),
un décollement placentaire (RC : 18; IC à 95 % : 11–29) ou une procidence du cordon
(RC : 30; IC à 95 % : 15–61) étaient les plus susceptibles de donner naissance à un
nouveau-né atteint d'EHI. Les deux tiers des nouveau-nés atteints d'EHI présentaient
un tracé de fréquence cardiaque fœtale intrapartum anormal. Le taux de mortalité chez
les enfants atteints d'EHI était de 27 % à l’âge de 3 ans. Le devenir neurodéveloppemental
des enfants survivants était normal chez 43 % d'entre eux. Un retard neurodéveloppemental
sévère a été observé chez 40 % des survivants.
Conclusion
Globalement, le taux d'EHI était faible chez les enfants nés à ≥ 35 SA. L'association
déterminée de l'EHI avec les facteurs intrapartum doit favoriser la surveillance accrue
dans ces situations cliniques et rappeler l'importance de la prise en charge attentive
afin d'optimiser le devenir des nouveau-nés.
Keywords
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Article info
Publication history
Published online: June 13, 2020
Footnotes
Disclosures: The project was funded by the Department of Obstetrics & Gynaecology, Dalhousie University.
All authors have indicated that they meet the journal's requirements for authorship.
This project was presented in part at the Society of Obstetricians and Gynaecologists of Canada Annual Clinical and Scientific Conference, 2019.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
