title: The relationship between clinically identifiable intrapartum sentinel events and short-term outcome after therapeutic hypothermia.
abstract: OBJECTIVE
  To determine the impact of intrapartum sentinel events on short-term outcome post-hypothermia.
  
  
  METHODS
  Records of 77 infants of 36 weeks' gestation or more, who received therapeutic hypothermia, were reviewed. Some were delivered after a clinically identifiable intrapartum sentinel event (IISE). All survivors had brain magnetic resonance imaging (MRI) at 7 to 10 days of life. The primary outcome of neonatal death related to hypoxic-ischemic encephalopathy was compared in infants born with (n = 39) or without an IISE (n = 38). MRI abnormalities were also compared. Logistic regression analysis was used to determine the variables predicting the primary outcome.
  
  
  RESULTS
  The two groups had similar Apgar scores, initial blood pHs, and early neurologic examinations. Base deficit was more severe in the IISE group. Neonatal death and hypoxic-ischemic injury was shown on brain MRI with basal nuclei, cortical, and subcortical white matter lesions extending beyond the watershed areas in infants surviving beyond the neonatal period were more common in the IISE group (P = .014; OR 11.1; 95% CI 1.3-92.6; and P = .034; OR 4.1; 95% CI 1.1-14.9, respectively). Multivariate analysis identified IISE (P = .023; OR 12.2; 95% CI 1.4-105.8) to be independently associated with neonatal death.
  
  
  CONCLUSIONS
  IISEs are associated with neonatal death and severe injury as shown in brain MRI, even after hypothermia.
authors: Division of Neonatal-Perinatal Medicine, University of Michigan Health System, C. S. Mott Children's Hospital, Ann Arbor, MI, USA. subratas@med.umich.edu
authors: Subrata
authors: S
authors: Sarkar
authors: Steven M
authors: SM
authors: Donn
authors: Jayapalli R
authors: JR
authors: Bapuraj
authors: Indira
authors: I
authors: Bhagat
authors: Ronald E
authors: RE
authors: Dechert
authors: John D
authors: JD
authors: Barks