Is perinatal asphyxia predictable?

• Published in: BMC pregnancy and childbirth 2020-03, Vol.20 (1), p.186-186, Article 186
• Main Authors: Locatelli, Anna, Lambicchi, Laura, Incerti, Maddalena, Bonati, Francesca, Ferdico, Massimo, Malguzzi, Silvia, Torcasio, Ferruccio, Calzi, Patrizia, Varisco, Tiziana, Paterlini, Giuseppe
• Format: Article
• Language: English
• Subjects: Apgar Score; Asphyxia Neonatorum - epidemiology; Birth injuries; Brain damage; Cesarean section; Childbirth & labor; Electronic monitoring; Female; Fetal heart rate monitoring; Fever; Health risk assessment; Heart Rate, Fetal; Humans; Hypothermia; Hypoxia; Hypoxia-Ischemia, Brain - epidemiology; Hypoxic-ischemic encephalopathy; asphyxia; sentinel events; Incidence; Infant; Infant, Newborn; Ischemia; Italy - epidemiology; Male; Metabolism; Nulliparity; Pregnancy; Pregnancy complications; Probability; Prospective Studies; Risk Factors; Suffocation; Umbilical artery pH; Womens health
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-020-02876-1

The objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management. We did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age ≥ 35 weeks, birthweight ≥1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH ≤7.0 or Base Excess (BE) ≤ - 12 mMol/L in Umbical Artery (UA) or within 1 h, 10 min Apgar  10 min. FHR monitoring was classified in three categories according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancies were divided into four classes: 1) low risk; 2) antepartum risk; 3) intrapartum risk; 4) and both ante and intrapartum risk. In the first six hours of life asphyxiated neonates were evaluated using the Thomson score (TS): if TS ≥ 5 neonates were transferred to Hub for further assessment; if TS ≥ 7 hypothermia was indicated. Perinatal asphyxia occurred in 21.5‰ cases (321/14,896) and HIE in 1.1‰ (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p