Acute fetal asphyxia and permanent brain injury: a retrospective analysis of current indicators.
OBJECTIVE
To determine whether a term neonate who has had sufficient intrapartum asphyxia to produce persistent brain injury will manifest the following four criteria: profound acidemia (arterial pH <7.00), an APGAR score < or =3 for 5 min or longer, seizures within 24 h of birth, and multiorgan system dysfunction.


METHODS
Singleton, liveborn, neurologically impaired neonates > or =37 weeks gestation who lived at least 6 days and had sufficient documentation of current intrapartum asphyxia criteria were retrospectively analyzed. Of these infants, solely neonates with acute fetal asphyxia due to a sudden prolonged FHR deceleration that lasted until delivery from a catastrophic event, e.g., uterine rupture, cord prolapse, were included. Organ system dysfunction was defined by separate criteria for each organ system. Dysfunction in one or more was defined as multiorgan system dysfunction.


RESULTS
Of the 292 eligible infants in the registry, 47 satisfied the entry criteria. In these 47 neonates, 10 (21%) satisfied all 4 criteria for intrapartum asphyxia.


CONCLUSIONS
Our retrospective study suggests that currently used indicators to define permanent fetal brain injury are not valid.
Korst
L M
LM
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Phelan
J P
JP
Wang
Y M
YM
Martin
G I
GI
Ahn
M O
MO
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000150:complications*; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology*; D002547:Cerebral Palsy / Q000209:etiology; D005260:Female; D005312:Fetal Blood; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D008171:Lung Diseases / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D012640:Seizures