The objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management. We did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age ≥ 35 weeks, birthweight ≥1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH ≤7.0 or Base Excess (BE) ≤ − 12 mMol/L in Umbical Artery (UA) or within 1 h, 10 min Apgar < 5, or need for resuscitation > 10 min. FHR monitoring was classified in three categories according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancies were divided into four classes: 1) low risk; 2) antepartum risk; 3) intrapartum risk; 4) and both ante and intrapartum risk. In the first six hours of life asphyxiated neonates were evaluated using the Thomson score (TS): if TS ≥ 5 neonates were transferred to Hub for further assessment; if TS ≥ 7 hypothermia was indicated. Perinatal asphyxia occurred in 21.5‰ cases (321/14,896) and HIE in 1.1‰ (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p < 0.001, OR 0.59, 95% CI 0.45–0.79). 32/213 (15%) neonates were transferred from Spokes to Hub. Overall, 12/281 were treated with hypothermia. HIE occurred in 16/281 (5.7%) neonates: four grade I, eight grade II and four grade III. Incidence of HIE was not different between Hub and Spokes. Pregnancies resulting in asphyxiated neonates were classified as class 1) 1.1%, 2) 52.3%, 3) 3.2%, and 4) 43.4%. Sentinel events occurred in 23.5% of the cases and FHR was category II or III in 50.5% of the cases. 40.2% cases of asphyxia and 18.8% cases of HIE were not preceded by sentinel events or abnormal FHR. We identified at least one risk factor associated with all cases of HIE and with most cases of perinatal asphyxia. In absence of risk factors, the probability of developing perinatal asphyxia resulted extremely low. FHR monitoring alone is not a reliable tool for detecting the probability of eventual asphyxia.

中文翻译：

---

围产期窒息可预测吗？

我们研究的目的是评估围产期窒息和缺氧缺血性脑病（HIE）与产前和产时危险因素和/或胎儿心率（FHR）结果之间的关系，以改善母体和新生儿的管理。我们在2014年至2016年之间从四家医院（一个设有新生儿重症监护中心的枢纽中心和三个I级辐照中心）的网络中进行了一项前瞻性观察队列研究。胎龄≥35周，出生体重≥1800g，无致命畸形的新生儿如果被诊断患有围产期窒息，定义为pH≤7.0或脐动脉（UA）中碱过量（BE）≤− 12 mMol / L，或在1小时10分钟内Apgar <5或需要复苏> 10分钟内，则包括在内。根据美国妇产科学院（ACOG），将FHR监测分为三类。怀孕分为四类：1）低风险；2）产前风险；3）产时风险；4）以及产前和产时风险。在生命的头六个小时中，使用汤姆森评分（TS）评估窒息新生儿：如果TS≥5新生儿被转移到Hub进行进一步评估；如果指示TS≥7体温过低。围产期窒息发生率为21.5‰（321 / 14,896），而HIE发生率为1.1‰（16 / 14,896）。研究总人口由281例窒息新生儿组成：出生在Hub的68/5152（1.3％）和在Spoke的新生儿213/9744（2.2％）（p <0.001，OR 0.59，95％CI 0.45-0.79）。32/213（15％）新生儿从分支转移到中心。总体而言，有12/281例患者接受了低温治疗。HIE发生在16/281（5。7％）的新生儿：I级四个，II级八个和III级四个。Hub和Spoke之间的HIE发生率没有差异。导致窒息新生儿的怀孕被分类为1）1.1％，2）52.3％，3）3.2％和4）43.4％。前哨事件发生在23.5％的病例中，而FHR在II。或III类中占50.5％的病例。未出现前哨事件或异常FHR时有40.2％的窒息病例和18.8％的HIE病例。我们确定了至少一种与所有HIE病例和大多数围产期窒息病例相关的危险因素。在没有危险因素的情况下，发生围产期窒息的可能性极低。单独进行FHR监测并不是检测最终窒息可能性的可靠工具。Hub和Spoke之间的HIE发生率没有差异。导致窒息新生儿的怀孕被分类为1）1.1％，2）52.3％，3）3.2％和4）43.4％。前哨事件发生在23.5％的病例中，而FHR在II。或III类中占50.5％的病例。未出现前哨事件或异常FHR时有40.2％的窒息病例和18.8％的HIE病例。我们确定了至少一种与所有HIE病例和大多数围产期窒息病例相关的危险因素。在没有危险因素的情况下，发生围产期窒息的可能性极低。单独进行FHR监测并不是检测最终窒息可能性的可靠工具。Hub和Spoke之间的HIE发生率没有差异。导致窒息新生儿的怀孕被分类为1）1.1％，2）52.3％，3）3.2％和4）43.4％。前哨事件发生在23.5％的病例中，而FHR在II。或III类中占50.5％的病例。未出现前哨事件或异常FHR时有40.2％的窒息病例和18.8％的HIE病例。我们确定了至少一种与所有HIE病例和大多数围产期窒息病例相关的危险因素。在没有危险因素的情况下，发生围产期窒息的可能性极低。单独进行FHR监测并不是检测最终窒息可能性的可靠工具。5％的病例中，FHR在50.5％的病例中为II类或III类。未出现前哨事件或异常FHR时有40.2％的窒息病例和18.8％的HIE病例。我们确定了至少一种与所有HIE病例和大多数围产期窒息病例相关的危险因素。在没有危险因素的情况下，发生围产期窒息的可能性极低。单独进行FHR监测并不是检测最终窒息可能性的可靠工具。5％的病例中，FHR在50.5％的病例中为II类或III类。未出现前哨事件或异常FHR时有40.2％的窒息病例和18.8％的HIE病例。我们确定了至少一种与所有HIE病例和大多数围产期窒息病例相关的危险因素。在没有危险因素的情况下，发生围产期窒息的可能性极低。单独进行FHR监测并不是检测最终窒息可能性的可靠工具。