Obstetric antecedents to body-cooling treatment of the newborn infant

David B. Nelson, Ashley M. Lucke, Donald D. McIntire, Pablo J. Sánchez, Kenneth J. Leveno, Lina F. Chalak

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Objective Obstetric antecedents were analyzed in births in which the infant received whole-body cooling for neonatal encephalopathy. Study Design 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/m2), 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)155.e1-155.e6
JournalAmerican journal of obstetrics and gynecology
Volume211
Issue number2
DOIs
StatePublished - Aug 2014

Keywords

  • perinatal acidemia
  • systemic hypothermia

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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