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Incidence, Intrapartum Risk Factors, and Prognosis of Neonatal Hypoxic-Ischemic Encephalopathy Among Infants Born at 35 Weeks Gestation or More

      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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