Diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy

Ernest M Graham, Rebecca R. Adami, Stephanie L. McKenney, Jacky Jennings, Irina Burd, Frank R Witter

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To estimate the diagnostic accuracy of electronic fetal heart rate abnormalities in the identification of neonates with encephalopathy treated with whole-body hypothermia. METHODS: Between January 1, 2007, and July 1, 2013, there were 39 neonates born at two hospitals within our system treated with whole-body hypothermia within 6 hours of birth. Neurologically normal control neonates were matched to each case by gestational age and mode of delivery in a two-to-one fashion. The last hour of electronic fetal heart rate monitoring before delivery was evaluated by three obstetricians blinded to outcome. RESULTS: The differences in tracing category were not significantly different (neonates in the case group 10.3% I, 76.9% II, 12.8% III; neonates in the control group 9.0% I, 89.7% II, 1.3% III; P5.18). Bivariate analysis showed neonates in the case group had significantly increased late decelerations, total deceleration area 30 (debt 30) and 60 minutes (debt 60) before delivery and were more likely to be nonreactive. Multivariable logistic regression showed neonates in the case group had a significant decrease in early decelerations (P5.03) and a significant increase in debt 30 (.01) and debt 60 (P5.005). The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72, 23.1%, and 94.9% for early decelerations; 0.66, 33.3%, and 87.2% for debt 30, and 0.68, 35.9%, and 89.7% for debt 60, respectively. CONCLUSION: Abnormalities during the last hour of fetal heart rate monitoring before delivery are poorly predictive of neonatal hypoxic-ischemic encephalopathy qualifying for whole-body hypothermia treatment within 6 hours of birth.

Original languageEnglish (US)
Pages (from-to)507-513
Number of pages7
JournalObstetrics and Gynecology
Volume124
Issue number3
DOIs
StatePublished - 2014

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Fetal Heart Rate
Deceleration
Brain Diseases
Hypothermia
Parturition
Brain Hypoxia-Ischemia
Congenital Heart Defects
ROC Curve
Gestational Age
Logistic Models
Sensitivity and Specificity
Control Groups

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

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Diagnostic accuracy of fetal heart rate monitoring in the identification of neonatal encephalopathy. / Graham, Ernest M; Adami, Rebecca R.; McKenney, Stephanie L.; Jennings, Jacky; Burd, Irina; Witter, Frank R.

In: Obstetrics and Gynecology, Vol. 124, No. 3, 2014, p. 507-513.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To estimate the diagnostic accuracy of electronic fetal heart rate abnormalities in the identification of neonates with encephalopathy treated with whole-body hypothermia. METHODS: Between January 1, 2007, and July 1, 2013, there were 39 neonates born at two hospitals within our system treated with whole-body hypothermia within 6 hours of birth. Neurologically normal control neonates were matched to each case by gestational age and mode of delivery in a two-to-one fashion. The last hour of electronic fetal heart rate monitoring before delivery was evaluated by three obstetricians blinded to outcome. RESULTS: The differences in tracing category were not significantly different (neonates in the case group 10.3{\%} I, 76.9{\%} II, 12.8{\%} III; neonates in the control group 9.0{\%} I, 89.7{\%} II, 1.3{\%} III; P5.18). Bivariate analysis showed neonates in the case group had significantly increased late decelerations, total deceleration area 30 (debt 30) and 60 minutes (debt 60) before delivery and were more likely to be nonreactive. Multivariable logistic regression showed neonates in the case group had a significant decrease in early decelerations (P5.03) and a significant increase in debt 30 (.01) and debt 60 (P5.005). The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72, 23.1{\%}, and 94.9{\%} for early decelerations; 0.66, 33.3{\%}, and 87.2{\%} for debt 30, and 0.68, 35.9{\%}, and 89.7{\%} for debt 60, respectively. CONCLUSION: Abnormalities during the last hour of fetal heart rate monitoring before delivery are poorly predictive of neonatal hypoxic-ischemic encephalopathy qualifying for whole-body hypothermia treatment within 6 hours of birth.",
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N2 - OBJECTIVE: To estimate the diagnostic accuracy of electronic fetal heart rate abnormalities in the identification of neonates with encephalopathy treated with whole-body hypothermia. METHODS: Between January 1, 2007, and July 1, 2013, there were 39 neonates born at two hospitals within our system treated with whole-body hypothermia within 6 hours of birth. Neurologically normal control neonates were matched to each case by gestational age and mode of delivery in a two-to-one fashion. The last hour of electronic fetal heart rate monitoring before delivery was evaluated by three obstetricians blinded to outcome. RESULTS: The differences in tracing category were not significantly different (neonates in the case group 10.3% I, 76.9% II, 12.8% III; neonates in the control group 9.0% I, 89.7% II, 1.3% III; P5.18). Bivariate analysis showed neonates in the case group had significantly increased late decelerations, total deceleration area 30 (debt 30) and 60 minutes (debt 60) before delivery and were more likely to be nonreactive. Multivariable logistic regression showed neonates in the case group had a significant decrease in early decelerations (P5.03) and a significant increase in debt 30 (.01) and debt 60 (P5.005). The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72, 23.1%, and 94.9% for early decelerations; 0.66, 33.3%, and 87.2% for debt 30, and 0.68, 35.9%, and 89.7% for debt 60, respectively. CONCLUSION: Abnormalities during the last hour of fetal heart rate monitoring before delivery are poorly predictive of neonatal hypoxic-ischemic encephalopathy qualifying for whole-body hypothermia treatment within 6 hours of birth.

AB - OBJECTIVE: To estimate the diagnostic accuracy of electronic fetal heart rate abnormalities in the identification of neonates with encephalopathy treated with whole-body hypothermia. METHODS: Between January 1, 2007, and July 1, 2013, there were 39 neonates born at two hospitals within our system treated with whole-body hypothermia within 6 hours of birth. Neurologically normal control neonates were matched to each case by gestational age and mode of delivery in a two-to-one fashion. The last hour of electronic fetal heart rate monitoring before delivery was evaluated by three obstetricians blinded to outcome. RESULTS: The differences in tracing category were not significantly different (neonates in the case group 10.3% I, 76.9% II, 12.8% III; neonates in the control group 9.0% I, 89.7% II, 1.3% III; P5.18). Bivariate analysis showed neonates in the case group had significantly increased late decelerations, total deceleration area 30 (debt 30) and 60 minutes (debt 60) before delivery and were more likely to be nonreactive. Multivariable logistic regression showed neonates in the case group had a significant decrease in early decelerations (P5.03) and a significant increase in debt 30 (.01) and debt 60 (P5.005). The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72, 23.1%, and 94.9% for early decelerations; 0.66, 33.3%, and 87.2% for debt 30, and 0.68, 35.9%, and 89.7% for debt 60, respectively. CONCLUSION: Abnormalities during the last hour of fetal heart rate monitoring before delivery are poorly predictive of neonatal hypoxic-ischemic encephalopathy qualifying for whole-body hypothermia treatment within 6 hours of birth.

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