Department of Neonatology, Sheril and Haim Saban Children Hospital, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel.
Department of Obstetrics and Gynecology, Soroka Medical Center, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel.
Pediatr Res. 2023 Sep;94(3):1119-1124. doi: 10.1038/s41390-023-02575-5. Epub 2023 Mar 24.
Hypoxic-ischemic encephalopathy (HIE) is an important contributor to disability worldwide. The current cardiotocography (CTG) predictive value for neonatal outcome is limited.
To assess the association of intrapartum CTG deceleration and acceleration areas with early MRI cerebral pathology in infants with HIE.
Term and near-term low-risk pregnancies that resulted in HIE, treated with therapeutic hypothermia with sufficient CTG records from a single, tertiary hospital between 2013 and 2021 were enrolled. Accelerations and decelerations areas, their minimum and maximum depths, and duration were calculated as well as the acceleration-to-deceleration area ratio during the 120 min prior to delivery. These data were assessed for associations with higher degrees of abnormality on early MRI scans.
A total of 77 infants were included in the final analysis. Significant associations between increased total acceleration area (p = 0.007) and between a higher acceleration-to-deceleration area ratio (p = 0.003) and better MRI results were detected.
In neonates treated for HIE, acceleration area and acceleration-to-deceleration ratio are associated with the risk of neonatal brain MRI abnormalities. To increase the role of these measurements as a relevant clinical tool, larger, more powered prospective trials are needed, using computerized real-time analysis.
The current cardiotocography predictive value for neonatal outcome is limited. This study aimed to assess the association of intrapartum deceleration and acceleration areas with the degree of cerebral injury in early cerebral MRI of neonates with encephalopathy. Lower acceleration area and acceleration-to-deceleration ratio were found to be associated with a higher degree of neonatal brain injury. Brain MRI is a marker of long-term outcome; its association with cardiotocography indices supports their association with long-term outcome in these neonates. Future computer-based CTG area analysis could assist in delivery room decision making to better time interventions and prevent hypoxic-ischemic encephalopathy.
缺氧缺血性脑病（HIE）是全球残疾的重要原因。目前，胎心监护（CTG）对新生儿结局的预测价值有限。
评估产时 CTG 减速和加速区域与 HIE 婴儿早期 MRI 脑病理的相关性。
纳入了 2013 年至 2021 年期间，在一家三级医院接受治疗性低温治疗的足月和近足月低风险 HIE 妊娠，并具有足够 CTG 记录的婴儿。计算减速和加速区域及其最小和最大深度以及持续时间，以及分娩前 120 分钟内的加速-减速区域比。这些数据被评估与早期 MRI 扫描中更高程度的异常之间的关联。
最终分析共纳入 77 例婴儿。发现总加速区域增加（p=0.007）和加速-减速区域比更高（p=0.003）与更好的 MRI 结果之间存在显著相关性。
在接受 HIE 治疗的新生儿中，加速区域和加速-减速比与新生儿脑 MRI 异常的风险相关。为了增加这些测量值作为相关临床工具的作用，需要使用计算机实时分析进行更大、更有力的前瞻性试验。
目前的胎心监护对新生儿结局的预测价值有限。本研究旨在评估产时减速和加速区域与脑病新生儿早期脑 MRI 中脑损伤程度的相关性。较低的加速区域和加速-减速比与更高程度的新生儿脑损伤相关。脑 MRI 是长期预后的标志物；它与胎心监护指数的相关性支持它们与这些新生儿长期预后的相关性。未来基于计算机的 CTG 区域分析可以协助产房决策，以更好地把握干预时机并预防缺氧缺血性脑病。
