Details

Autor(en) / Beteiligte

• Nelson, David B., MD
• Lucke, Ashley M., MD
• McIntire, Donald D., PhD
• Sánchez, Pablo J., MD
• Leveno, Kenneth J., MD
• Chalak, Lina F., MD

Titel

Obstetric antecedents to body-cooling treatment of the newborn infant

Ist Teil von

• American journal of obstetrics and gynecology, 2014-08, Vol.211 (2), p.155.e1-155.e6

Ort / Verlag

United States: Mosby, Inc

Erscheinungsjahr

2014

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Objective Obstetric antecedents were analyzed in births in which the infant received whole-body cooling for neonatal encephalopathy. Study Design This retrospective cohort study included all live-born singleton infants delivered at or beyond 36 weeks' gestation from October 2005 through December 2011. Infants who had received whole-body cooling identified by review of a prospective neonatal registry were compared with a control group comprising the remaining obstetric population delivered at greater than 36 weeks but not cooled. Univariable analysis was followed up by a staged, stepwise selection of variables with the intent to rank significant risk factors for cooling. Results A total of 86,371 women delivered during the study period and 98 infants received whole-body cooling (1.1 per 1000 live births). Of these 98 infants, 80 newborns (88%) had moderate encephalopathy and 10 (12%) had severe encephalopathy prior to cooling. Maternal age of 15 years or younger, low parity, maternal body habitus (body mass index of ≥40 kg/m2 ), diabetes, preeclampsia, induction, epidural analgesia, chorioamnionitis, length of labor, and mode of delivery were associated with significantly increased risk of infant cooling during a univariable analysis. Catastrophic events to include umbilical cord prolapse (odds ratio [OR], 14; 95% confidence interval [CI], 3–72), placental abruption (OR, 17; 95% CI, 7–44), uterine rupture (OR, 130; 95% CI, 11–1477) were the strongest factors associated with infant cooling after staged-stepwise logistic analysis. Conclusion A variety of intrapartum characteristics were associated with infant cooling for neonatal encephalopathy, with the most powerful antecedents being umbilical cord prolapse, placental abruption, and uterine rupture.