Key result
Neonates who developed seizures secondary to HIE had a significantly longer duration of abnormal fetal heart rate patterns compared to matched controls (72 ± 12 vs 48 ± 12 minutes, p < 0.001).
Why the study?
What are the differences in intrapartum fetal heart rate parameters between neonates with severe acidosis who develop seizures versus those who do not?
Case-Control (n=50)
What are the differences in intrapartum fetal heart rate parameters between neonates with severe acidosis who develop seizures versus those who do not?
Absolute Event Rate: 72% vs 48%
p-value: p=< 0.001
In neonates with severe acidosis, a longer duration of abnormal intrapartum fetal heart rate patterns is associated with the development of seizures secondary to hypoxic ischemic encephalopathy.
Prolonged abnormal FHR may flag seizure risk in acidotic neonates; hypothesis-generating, needs prospective validation before practice change.
OBJECTIVE: To determine which intrapartum fetal heart rate parameters in the presence of severe neonatal acidosis (pH < 7.0) appropriately predicts the development of neonatal seizures in the context of hypoxic ischemic encephalopathy (HIE). METHODS: The intrapartum fetal heart rate tracings of 25 neonates who developed neonatal seizures secondary to HIE were compared with 25 matched neonates with similar pH and gestational age who did not develop seizures. All patients had at least 2 hours of intrapartum fetal heart rate patterns available for review. We compared the fetal heart rate parameters of prolonged deceleration, variable and late decelerations, variability, accelerations, fetal heart rate baseline and duration of the fetal heart rate abnormality. Comparison between the groups was done using chi-square for nominal data and student t-tests for continuous data. RESULTS: Neonates with seizures 2 degrees HIE had a significantly longer duration of abnormal fetal heart rate patterns (72 +/- 12 minutes vs 48 +/- 12 minutes, p < 0.001). DISCUSSION: This study demonstrated that in the setting of neonatal acidosis the development of seizures is related to the period of stress (duration of the abnormal fetal heart rate pattern).
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Williams et al. (2004) conducted a case-control in Severe neonatal acidosis (pH < 7.0) and hypoxic ischemic encephalopathy (HIE) (n=50). Neonatal seizures secondary to HIE vs. Matched neonates with similar pH and gestational age who did not develop seizures was evaluated on Duration of abnormal fetal heart rate patterns (p=< 0.001). Neonates who developed seizures secondary to HIE had a significantly longer duration of abnormal fetal heart rate patterns compared to matched controls (72 ± 12 vs 48 ± 12 minutes, p < 0.001).
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