title: Obstetric antecedents to body-cooling treatment of the newborn infant.
abstract: OBJECTIVE
  Obstetric antecedents were analyzed in births in which the infant received whole-body cooling for neonatal encephalopathy.
  
  
  METHODS
  This retrospective cohort study included all live-born singleton infants delivered at or beyond 36 weeks' gestation from October 2005 through December 2011. Infants who had received whole-body cooling identified by review of a prospective neonatal registry were compared with a control group comprising the remaining obstetric population delivered at greater than 36 weeks but not cooled. Univariable analysis was followed up by a staged, stepwise selection of variables with the intent to rank significant risk factors for cooling.
  
  
  RESULTS
  A total of 86,371 women delivered during the study period and 98 infants received whole-body cooling (1.1 per 1000 live births). Of these 98 infants, 80 newborns (88%) had moderate encephalopathy and 10 (12%) had severe encephalopathy prior to cooling. Maternal age of 15 years or younger, low parity, maternal body habitus (body mass index of ≥40 kg/m(2)), diabetes, preeclampsia, induction, epidural analgesia, chorioamnionitis, length of labor, and mode of delivery were associated with significantly increased risk of infant cooling during a univariable analysis. Catastrophic events to include umbilical cord prolapse (odds ratio [OR], 14; 95% confidence interval [CI], 3-72), placental abruption (OR, 17; 95% CI, 7-44), uterine rupture (OR, 130; 95% CI, 11-1477) were the strongest factors associated with infant cooling after staged-stepwise logistic analysis.
  
  
  CONCLUSIONS
  A variety of intrapartum characteristics were associated with infant cooling for neonatal encephalopathy, with the most powerful antecedents being umbilical cord prolapse, placental abruption, and uterine rupture.
authors: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. Electronic address: davidb.nelson@utsouthwestern.edu.
authors: David B
authors: DB
authors: Nelson
authors: Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
authors: Ashley M
authors: AM
authors: Lucke
authors: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
authors: Donald D
authors: DD
authors: McIntire
authors: Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
authors: Pablo J
authors: PJ
authors: Sánchez
authors: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
authors: Kenneth J
authors: KJ
authors: Leveno
authors: Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
authors: Lina F
authors: LF
authors: Chalak
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002821:Chorioamnionitis / Q000453:epidemiology; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology; D011391:Prolapse; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014470:Umbilical Cord; D014597:Uterine Rupture / Q000453:epidemiology; D055815:Young Adult
keywords: perinatal acidemia; systemic hypothermia