Correlation between fetal heart rate evolution patterns and magnetic resonance imaging findings in severe cerebral palsy: A longitudinal study

Autor: Masahiro Nakao, Yukiko Nanba, Asumi Okumura, Junichi Hasegawa, Satoshi Toyokawa, Kiyotake Ichizuka, Naohiro Kanayama, Shoji Satoh, Nanako Tamiya, Akihito Nakai, Keiya Fujimori, Tsugio Maeda, Hideaki Suzuki, Mitsutoshi Iwashita, Akira Oka, Tomoaki Ikeda
Rok vydání: 2022
Předmět:
Zdroj: BJOG: An International Journal of Obstetrics & Gynaecology. 129:1574-1582
ISSN: 1471-0528
1470-0328
Popis: To investigate the association between hypoxic-ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP).Longitudinal study.Database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy.Infants with severe CP born at ≥34 weeks of gestation.The intrapartum fetal heart rate (FHR) strips were categorised as continuous bradycardia; persistently non-reassuring (NR-NR); reassuring-prolonged deceleration (R-PD); Hon's pattern (R-Hon); persistently reassuring (R-R); and unclassified. The brain magnetic resonance imaging (MRI) scans were categorised based on the predominant site involved: basal ganglia-thalamus (BGT); white matter (WM); watershed (WS); stroke; normal; and unclassified.Manifestations of the brain MRI types and the association between FHR evolution pattern and MRI type were analysed.Among 672 eligible infants, 76% had BGT-dominant injury, 5.4% WM, 1.2% WS, 1.6% stroke, 1.9% normal, and 14% unclassified. Placental abruption and small-for-gestational age were associated with an increased (adjusted odds ratio [aOR] 8.02) and decreased (aOR 0.38) risk of BGT injury, respectively. The majority of infants had BGT injury in most FHR groups (bradycardia, 97%; NR-NR, 75%; R-PD, 90%; R-Hon, 76%; and R-R, 45%). The risk profiles in case of BGT in the NR-NR group were similar to those in the R-PD and R-Hon groups.BGT-dominant brain damage accounted for three-fourths of the cases of CP in term or near-term infants, even in prenatal onset cases. Hypoxic-ischaemic insult has a major impact on CP development during the antenatal period.Basal ganglia-thalamus injury constitutes 76% of severe cerebral palsy cases, predominant even in antenatal-onset cases.
Databáze: OpenAIRE
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