title: Evaluating the Sensitivity of Electronic Fetal Monitoring Patterns for the Prediction of Intraventricular Hemorrhage.
abstract: ObjectiveWe evaluated electronic fetal (heart rate) monitoring (EFM) patterns among very preterm infants with and without intraventricular hemorrhage (IVH) to evaluate the test characteristics of EFM for the prediction of IVH.Study DesignWe performed a case-control study of preterm infants born ≤ 30 weeks' gestation over a 6-year period. We evaluated differences in EFM patterns between those (cases) with and without IVH (controls). The relative odds ratio of observing differences in EFM patterns between cases and controls was calculated. Regression models were adjusted based on confounding variables. The sensitivity, specificity, and positive and negative predictive values of EFM characteristics were evaluated for the diagnosis of IVH.ResultsTotal 79 very preterm infants underwent cranial ultrasound, 24 of whom had IVH. Infants with IVH were more likely to be males and delivered at earlier gestational ages. Moderate variability was seen in all infants with normal cranial ultrasounds and 83% of infants with IVH. Minimal variability has a sensitivity of 17% in the prediction of IVH.ConclusionWhile minimal variability was observed more frequently in fetuses that developed IVH, it is poorly predictive of IVH. EFM patterns are not discriminating in identifying very preterm infants at risk for developing IVH.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hannaford
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri.
authors.forename: Molly J
authors.initials: MJ
authors.lastname: Stout
authors.affiliation: Departments of Neurology and Pediatrics, Washington University, St. Louis, Missouri.
authors.forename: Chris D
authors.initials: CD
authors.lastname: Smyser
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Washington University, St. Louis, Missouri.
authors.forename: Amit
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000328:Adult; D015148:Cardiotocography / Q000379:methods*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D008923:Missouri / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography / Q000379:methods; D055815:Young Adult