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

BMJ 1998;317:1554-1558 ( 5 December )

Papers

Intrapartum 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, Western Australia 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 identify intrapartum 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%. Maternal pyrexia (odds ratio 3.82), a persistentoccipitoposterior position (4.29), and an acute intrapartum event(4.44) were all risk factors for newborn encephalopathy. Morecase infants than control infants were induced (41.5% and 30.5%,respectively) and fewer case infants were delivered by caesareansection without labour (3.7% and 14.5%, respectively). Operativevaginal delivery (2.34) and emergency caesarean section (2.17)were both associated with an increased risk. There was an inverserelation between elective caesarean section (0.17) and newbornencephalopathy. After application of a set of consensus criteriafor elective caesarean section only three (7%) eligible case motherscompared with 33 (65%) eligible control mothers were sectionedelectively. Of all the case infants, 113 (69%) had only antepartumrisk factors for newborn encephalopathy identified; 39 (24%) hadantepartum and intrapartum factors; eight (5%) had only intrapartumfactors; and four (2%) had no recognised antepartum or intrapartumfactors.
Conclusions: The causes of newborn encephalopathy are heterogeneousand many relate to the antepartum period. Elective caesarean sectionhas an inverse association with newborn encephalopathy. Intrapartumhypoxia alone accounts for only a small proportion of newbornencephalopathy. These results question the view that most riskfactors for newborn encephalopathy lie in the intrapartumperiod.

Key messages

Intrapartum risk factors for newborn encephalopathy include maternal pyrexia, persistent occipitoposterior position, and acute intrapartum events
Operative vaginal delivery and emergency caesarean section were both associated with an increased risk whereas there was an inverse relation with elective caesarean section
There was no evidence of intrapartum hypoxia in over 70% of cases of newborn encephalopathy
The causes of newborn encephalopathy are heterogeneous and many relate to the antepartum period
These findings bring into question the view that most risk factors for newborn encephalopathy lie in the intrapartum period

© BMJ 1998

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Antepartum risk factors for newborn encephalopathy: Matthew Ellis, Anthony M de L Costello, Deirdre J Murphy, Nadia Badawi, Jennifer J Kurinczuk, Fiona J Stanley, John M Keogh, and Paul R Burton
BMJ 1999 318: 1414. [Extract] [Full Text] [PDF]

Looking after infants
BMJ 1998 317: 0. [Full Text] [PDF]

Neonatal encephalopathies: A D Edwards and K B Nelson
BMJ 1998 317: 1537-1538. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Malaeb, S., Dammann, O. (2009). Fetal Inflammatory Response and Brain Injury in the Preterm Newborn. J Child Neurol 24: 1119-1126 [Abstract]
Laptook, A., Tyson, J., Shankaran, S., McDonald, S., Ehrenkranz, R., Fanaroff, A., Donovan, E., Goldberg, R., O'Shea, T. M., Higgins, R. D., Poole, W. K., and the National Institute of Child Health and Hum, (2008). Elevated Temperature After Hypoxic-Ischemic Encephalopathy: Risk Factor for Adverse Outcomes. Pediatrics 122: 491-499 [Abstract] [Full text]
Okereafor, A., Allsop, J., Counsell, S. J., Fitzpatrick, J., Azzopardi, D., Rutherford, M. A., Cowan, F. M. (2008). Patterns of Brain Injury in Neonates Exposed to Perinatal Sentinel Events. Pediatrics 121: 906-914 [Abstract] [Full text]
Lee, A. CC., Mullany, L. C., Tielsch, J. M., Katz, J., Khatry, S. K., LeClerq, S. C., Adhikari, R. K., Shrestha, S. R., Darmstadt, G. L. (2008). Risk Factors for Neonatal Mortality Due to Birth Asphyxia in Southern Nepal: A Prospective, Community-Based Cohort Study. Pediatrics 121: e1381-e1390 [Abstract] [Full text]
Pasupathy, D., Smith, G. C S (2008). Neonatal outcomes with caesarean delivery at term. Arch. Dis. Child. Fetal Neonatal Ed. 93: F174-F175 [Full text]
Johnson, C. P., Myers, S. M., and the Council on Children With Disabilities, (2007). Identification and Evaluation of Children With Autism Spectrum Disorders. Pediatrics 120: 1183-1215 [Abstract] [Full text]
Blume, H. K., Loch, C. M., Li, C. I. (2007). Neonatal Encephalopathy and Socioeconomic Status: Population-Based Case-Control Study. Arch Pediatr Adolesc Med 161: 663-668 [Abstract] [Full text]
Keogh, J. M. (2007). Determinants of Outcome After Head Cooling for Neonatal Encephalopathy. Pediatrics 120: 171-172 [Full text]
Gonzalez, F F, Miller, S P (2006). Does perinatal asphyxia impair cognitive function without cerebral palsy?. Arch. Dis. Child. Fetal Neonatal Ed. 91: F454-F459 [Abstract] [Full text]
Shah, P. S., Beyene, J., To, T., Ohlsson, A., Perlman, M. (2006). Postasphyxial Hypoxic-Ischemic Encephalopathy in Neonates: Outcome Prediction Rule Within 4 Hours of Birth. Arch Pediatr Adolesc Med 160: 729-736 [Abstract] [Full text]
Wainwright, H C (2006). My approach to performing a perinatal or neonatal autopsy.. J. Clin. Pathol. 59: 673-680 [Abstract] [Full text]
Smith, G. C.S., White, I. R. (2006). Predicting the Risk for Sudden Infant Death Syndrome From Obstetric Characteristics: A Retrospective Cohort Study of 505011 Live Births. Pediatrics 117: 60-66 [Abstract] [Full text]
Armstead, W. M., Cines, D. B., Higazi, A. A.-R. (2005). Plasminogen Activators Contribute to Impairment of Hypercapnic and Hypotensive Cerebrovasodilation After Cerebral Hypoxia/Ischemia in the Newborn Pig. Stroke 36: 2265-2269 [Abstract] [Full text]
Marlow, N, Rose, A S, Rands, C E, Draper, E S (2005). Neuropsychological and educational problems at school age associated with neonatal encephalopathy. Arch. Dis. Child. Fetal Neonatal Ed. 90: F380-F387 [Abstract] [Full text]
Bell, J. E., Becher, J.-C., Wyatt, B., Keeling, J. W., McIntosh, N. (2005). Brain damage and axonal injury in a Scottish cohort of neonatal deaths. Brain 128: 1070-1081 [Abstract] [Full text]
Pierrat, V, Haouari, N, Liska, A, Thomas, D, Subtil, D, Truffert, P, on behalf of the Groupe d'Etudes en Epidemiologie, (2005). Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study. Arch. Dis. Child. Fetal Neonatal Ed. 90: F257-f261 [Abstract] [Full text]
Paneth, N., Korzeniewski, S., Hong, T. (2005). The Role of the Intrauterine and Perinatal Environment in Cerebral Palsy. NeoReviews 6: e133-e140 [Full text]
Landon, M. B., Hauth, J. C., Leveno, K. J., Spong, C. Y., Leindecker, S., Varner, M. W., Moawad, A. H., Caritis, S. N., Harper, M., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B., Langer, O., Thorp, J. M., Ramin, S. M., Mercer, B. M., Gabbe, S. G., the National Institute of Child Health and Human D, (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. NEJM 351: 2581-2589 [Abstract] [Full text]
Ferriero, D. M. (2004). Neonatal Brain Injury. NEJM 351: 1985-1995 [Full text]
Becher, J C, Bell, J E, Keeling, J W, McIntosh, N, Wyatt, B (2004). The Scottish perinatal neuropathology study: clinicopathological correlation in early neonatal deaths. Arch. Dis. Child. Fetal Neonatal Ed. 89: F399-F407 [Abstract] [Full text]
Patel, R. R, Murphy, D. J (2004). Forceps delivery in modern obstetric practice. BMJ 328: 1302-1305 [Full text]
Mercuri, E, Anker, S, Guzzetta, A, Barnett, A L, Haataja, L, Rutherford, M, Cowan, F, Dubowitz, L, Braddick, O, Atkinson, J (2004). Visual function at school age in children with neonatal encephalopathy and low Apgar scores. Arch. Dis. Child. Fetal Neonatal Ed. 89: F258-F262 [Abstract] [Full text]
Kariminia, A., Chamberlain, M. E, Keogh, J., Shea, A. (2004). Randomised controlled trial of effect of hands and knees posturing on incidence of occiput posterior position at birth. BMJ 328: 490- [Abstract] [Full text]
Wu, Y. W., Escobar, G. J., Grether, J. K., Croen, L. A., Greene, J. D., Newman, T. B. (2003). Chorioamnionitis and Cerebral Palsy in Term and Near-Term Infants. JAMA 290: 2677-2684 [Abstract] [Full text]
Draper, E S, Kurinczuk, J J, Lamming, C R, Clarke, M, James, D, Field, D (2002). A confidential enquiry into cases of neonatal encephalopathy. Arch. Dis. Child. Fetal Neonatal Ed. 87: F176-180 [Abstract] [Full text]
Glinianaia, S V, Pharoah, P O D, Wright, C, Rankin, J M (2002). Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor. Arch. Dis. Child. Fetal Neonatal Ed. 86: F9-15 [Abstract] [Full text]
Impey, L, Greenwood, C, Sheil, O, MacQuillan, K, Reynolds, M, Redman, C (2001). The relation between pre-eclampsia at term and neonatal encephalopathy. Arch. Dis. Child. Fetal Neonatal Ed. 85: F170-172 [Abstract] [Full text]
Azzopardi, D., Robertson, N. J., Cowan, F. M., Rutherford, M. A., Rampling, M., Edwards, A. D. (2000). Pilot Study of Treatment With Whole Body Hypothermia for Neonatal Encephalopathy. Pediatrics 106: 684-694 [Abstract] [Full text]
Ellis, M., Manandhar, N., Manandhar, D. S, Costello, A. M d. L (2000). Risk factors for neonatal encephalopathy in Kathmandu, Nepal, a developing country: unmatched case-control study. BMJ 320: 1229-1236 [Abstract] [Full text]
Marik, P. E. (2000). Fever in the ICU. Chest 117: 855-869 [Abstract] [Full text]
Bakketeig, L. S (1999). Only a minor part of cerebral palsy cases begin in labour. BMJ 319: 1016-1017 [Full text]
Ellis, M., Costello, A. M d. L, Murphy, D. J, Badawi, N., Kurinczuk, J. J, Stanley, F. J, Keogh, J. M, Burton, P. R (1999). Antepartum risk factors for newborn encephalopathy. BMJ 318: 1414-1414 [Full text]
Edwards, A D, Nelson, K B (1998). Neonatal encephalopathies. BMJ 317: 1537-1538 [Full text]
Badawi, N., Kurinczuk, J. J, Keogh, J. M, Alessandri, L. M, O'Sullivan, F., Burton, P. R, Pemberton, P. J, Stanley, F. J (1998). Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 317: 1549-1553 [Abstract] [Full text]