Nuchal cord and neurodevelopmental performance at 1 year.
OBJECTIVE
To test the null hypothesis that the presence of a nuchal cord at delivery has no effect on neurodevelopmental performance at 1 year of age.


METHODS
The offspring of 190 women with clinically normal antenatal courses were evaluated within 1 month of their first birthday by a blinded observer using the Bayley Scales of Infant Development. The cases were grouped based on the presence of a symptomatic nuchal cord during labor (abnormal fetal heart rate patterns or meconium), and significant differences were detected using analysis of variance.


RESULTS
A symptomatic nuchal cord was present during labor and delivery in 24% of the 190 cases. At 1 year of age scores on both Bayley scales were slightly but significantly (P < .01) lower in the offspring delivered with a symptomatic nuchal cord. The mental index was 116 +/- 9 versus 120 +/- 7, and the psychomotor index was 101 +/- 11 versus 107 +/- 9. These differences were accentuated (P = .09) when the symptomatic cases complicated by extreme tightness, multiple loops, or antenatal detection were compared to symptomatic cases without these additional complications (overall index 110 +/- 8 versus 105 +/- 10). There were no between group differences in multiple potential confounding obstetric or demographic variables.


CONCLUSIONS
These data do not support the null hypothesis and suggest that symptomatic nuchal cords, which are identified before labor as being extremely tight or having multiple loops, may be associated with a subclinical deficit in neurodevelopmental performance at 1 year of age.
Clapp
J F
JF
Department of Obstetrics and Gynecology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA. jfclapp@metrohealth.org
Lopez
B
B
Simonean
S
S
D000328:Adult; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D007223:Infant; D009333:Neck / Q000196:embryology*; D009420:Nervous System / Q000254:growth & development*; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D014470:Umbilical Cord