Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study

BMJ 1998;317:1549-1553 ( 5 December )

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Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study

Editorial by Edwards

Nadia Badawi, neonatologist, ^a Jennifer J Kurinczuk, epidemiologist, ^a John M Keogh, obstetrician, ^b Louisa M Alessandri, senior research officer, ^a Fiona O'Sullivan, research midwife, ^a Paul R Burton, senior biostatistician, ^c Patrick J Pemberton, neonatologist, ^d Fiona J Stanley, director. ^a

^a TVW Telethon Institute for Child Health Research, PO Box 855, West Perth, Western Australia 6872, Australia, ^b Department of Obstetrics and Gynaecology, Hornsby Ku-ring-Gai Hospital, Hornsby, New South Wales 2077, Australia, ^c Department of Paediatrics, University of Western Australia, Western Australia 6907, Australia, ^d Princess Margaret Hospital for Children, Subiaco, WA 6008, Australia

Correspondence to: Dr N Badawi, Department of Neonatology, New Children's Hospital, Royal Alexandra Hospital for Children, PO Box 3515, Parramatta, New South Wales, New South Wales 2124, Australia nadiaB{at}nch.edu.au

Objective: To ascertain antepartum predictors of newbornencephalopathy in terminfants.
Design: Population based, unmatched case-control study.
Setting: Metropolitan area of Western Australia, June1993 to September1995.
Subjects: All 164 term infants with moderate or severenewborn encephalopathy; 400 randomly selectedcontrols.
Main outcome measures: Adjusted odds ratioestimates.
Results: The birth prevalence of moderate or severenewborn encephalopathy was 3.8/1000 term live births. The neonatalfatality was 9.1%. The risk of newborn encephalopathy increasedwith increasing maternal age and decreased with increasing parity.There was an increased risk associated with having a mother whowas unemployed (odds ratio 3.60), an unskilled manual worker (3.84),or a housewife (2.48). Other risk factors from before conceptionwere not having private health insurance (3.46), a family historyof seizures (2.55), a family history of neurological disease (2.73),and infertility treatment (4.43). Risk factors during pregnancywere maternal thyroid disease (9.7), severe pre-eclampsia (6.30),moderate or severe bleeding (3.57), a clinically diagnosed viralillness (2.97), not having drunk alcohol (2.91); and placentadescribed at delivery as abnormal (2.07). Factors related to thebaby were birth weight adjusted for gestational age between thethird and ninth centile (4.37) or below the third centile (38.23).The risk relation with gestational age was J shaped with 38 and39 weeks having the lowestrisk.
Conclusions: The causes of newborn encephalopathy are heterogeneousand many of the causal pathways start beforebirth.

Key messages

The birth prevalence of moderate or severe newborn encephalopathy was 3.8 per 1000 term live births and the neonatal case fatality was 9.1%
Independent risk factors before conception and in the antepartum period for newborn encephalopathy include socioeconomic status, family history of seizures or other neurological disease, conception after infertility treatment, maternal thyroid disease, severe pre-eclampsia, bleeding in pregnancy, viral illness, having an abnormal placenta, intrauterine growth restriction, and postmaturity
The causes of newborn encephalopathy are heterogeneous and many causal pathways start in the antepartum period

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