Whole-Body Hypothermia for Hypoxic-Ischemic Encephalopathy and Route of Delivery

Objective: To compare the antenatal and intrapartum characteristics of newborns at > 36.0 weeks, who underwent whole-body hypothermia for hypoxic ischemic encephalopathy (HIE) and had either cesarean versus vaginal deliveries. Methods: Retrospectively we identified all non-anomalous singletons at > 36.0 weeks who had HIE and underwent whole-body hypothermia at a community teaching hospital. Differences in baseline characteristics and intrapartum factors were compared among the cesarean versus vaginal deliveries using chi-squared tests. Multivariable Poisson regression models were used to estimate the association between delivery route and various outcomes with adjustment for potential confounders. Results: Of the 32,765 deliveries during the study period, 132 (0.4%) met the inclusion criteria and among them 79 (59.8%) had cesarean deliveries, and the remaining 53 (40.1%) vaginal births. The prenatal care providers (i.e. private, community hospital faculty or others) differed significantly between the two groups (P=0.013). Within 60 min of the hospitalization, the characteristics of fetal heart rate tracing (FHRT), and its category (I, II or III) did not differ between the groups. Sentinel events occurred among 25.3% of those that had cesarean and 30.2% of those that delivered vaginally (P=0.556). FHRT 60 min prior to delivery did not differ with regards to presence of decelerations (P=0.409), and variability (P=0.199), but whether it was category I, II or III (P=0.030) did vary significantly. The likelihood of neonatal seizure (adjusted incidence rate ratio 1.03; 95% confidence intervals 0.41-2.58) and mortality (1.10; 0.03-45.5) were similar between the groups. Conclusion: Occurring in about 4 per 1,000 deliveries at a community teaching hospital, the majority of singletons that had whole body cooling had cesarean delivery. While the category of FHRT did not differ significantly within 60 minutes of admission, it did differ 60 minutes before birth.