title: Electronic fetal monitoring patterns associated with respiratory morbidity in term neonates.
abstract: OBJECTIVE
  The purpose of this study was to identify electronic fetal monitoring patterns that are associated with neonatal respiratory morbidity.
  
  
  METHODS
  In an on-going prospective cohort study of >8000 consecutive term, vertex, nonanomalous singleton pregnancies during labor, we performed this analysis within the first 5000 women as a representative sample. Electronic fetal monitoring patterns in the 30 minutes preceding delivery were extracted by trained obstetrics research nurses, who were blinded to clinical data, using the National Institute of Child Health and Human Development system; the data were compared between those with respiratory morbidity and healthy infants (no morbidities). The primary outcome was neonatal respiratory morbidity, which was defined as either oxygen requirement at ≥6 hours of life or any mechanical ventilation in the first 24 hours. Multivariable logistic regression was used to adjust for confounders.
  
  
  RESULTS
  Of 4736 neonates, 175 (3.4%) experienced respiratory morbidity. Most electronic fetal monitoring patterns were category II (96.6%; n = 4575). Baseline tachycardia (adjusted odds ratio [aOR], 2.9; 95% confidence interval [CI], 1.9-4.4), marked variability (aOR, 2.7; 95% CI, 1.5-5.0), and prolonged decelerations (aOR,2.7; 95% CI, 1.5-5.0) were significantly associated with an increased likelihood of term neonatal respiratory morbidity. Accelerations and persistent moderate variability were both significantly associated with a decreased likelihood of respiratory morbidity.
  
  
  CONCLUSIONS
  Specific features of category II electronic fetal monitoring patterns make respiratory morbidity more likely in nonanomalous term infants. Tachycardia, marked variability, or prolonged decelerations before delivery can assist providers in anticipating the potential need for neonatal respiratory support.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO. Electronic address: liul@wudosis.wustl.edu.
authors.forename: Lucy
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000328:Adult; D015148:Cardiotocography; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D015999:Multivariate Analysis; D010100:Oxygen / Q000008:administration & dosage; D011247:Pregnancy; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000175:diagnosis*; D013610:Tachycardia / Q000453:epidemiology
chemical_list: D010100:Oxygen
keywords: electronic fetal monitoring; neonatal respiratory morbidity; term neonate