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 newborn encephalopathy in term infants.
Design: Population based, unmatched case-control study.
Setting: Metropolitan area of Western Australia, June 1993 to September 1995.
Subjects: All 164 term infants with moderate or severe newborn encephalopathy; 400 randomly selected controls.
Main outcome measures: Adjusted odds ratio estimates.
Results: The birth prevalence of moderate or severe newborn encephalopathy was 3.8/1000 term live births. The neonatal fatality was 9.1%. The risk of newborn encephalopathy increased with increasing maternal age and decreased with increasing parity. There was an increased risk associated with having a mother who was unemployed (odds ratio 3.60), an unskilled manual worker (3.84), or a housewife (2.48). Other risk factors from before conception were not having private health insurance (3.46), a family history of seizures (2.55), a family history of neurological disease (2.73), and infertility treatment (4.43). Risk factors during pregnancy were maternal thyroid disease (9.7), severe pre-eclampsia (6.30), moderate or severe bleeding (3.57), a clinically diagnosed viral illness (2.97), not having drunk alcohol (2.91); and placenta described at delivery as abnormal (2.07). Factors related to the baby were birth weight adjusted for gestational age between the third and ninth centile (4.37) or below the third centile (38.23). The risk relation with gestational age was J shaped with 38 and 39 weeks having the lowest risk.
Conclusions: The causes of newborn encephalopathy are heterogeneous and many of the causal pathways start before birth.

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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