Johns Hopkins University2014-12-03 4:22 PM

Diagnostic Accuracy of Fetal Heart Rate Monitoring in the Identification of Neonatal Encephalopathy


OBJECTIVE : To estimate the diagnostic accuracy of electronic fetal heart rate abnormalities in the identification of neonates with encephalopathy treated with whole-body hypothermia .

METHODS : Between January 1 , 2007, and July 1 , 2013 , there were 39 neonates born at two hospitals within our system treated with whole-body hypothermia within 6 hours of birth . Neurologically normal control neonates were matched to each case by gestational age and mode of delivery in a two-to-one fashion . The last hour of electronic fetal heart rate monitoring before delivery was evaluated by three obstetricians blinded to outcome .

RESULTS : The differences in tracing category were not significantly different (neonates in the case group 10.3% I , 76.9% II , 12.8% III ; neonates in the control group 9.0% I , 89.7% II , 1.3% III ; P=.18) . 

Bivariate analysis showed neonates in the case group had significantly increased late decelerations , total deceleration area 30 (debt 30) and 60 minutes (debt 60) before delivery and were more likely to be nonreactive . Multivariable logistic regression showed neonates in the case group had a significant decrease in early decelerations (P=.03) and a significant increase in debt 30 (.01) and debt 60 (P=.005) . 

The area under the receiver operating characteristic curve , sensitivity , and specificity were 0.72, 23.1% , and 94.9% for early decelerations; 0.66, 33.3%, and 87.2% for debt 30 , and 0.68, 35.9% , and 89.7% for debt 60, respectively .

CONCLUSION : Abnormalities during the last hour of fetal heart rate monitoring before delivery are poorly predictive of neonatal hypoxic–ischemic encephalopathy qualifying for whole-body hypothermia treatment within 6 hours of birth .


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