Cortney Kirkendall

Nucleated red blood cell and platelet counts in asphyxiated neonates sufficient to result in permanent neurologic impairment.

Objective. Recent research has suggested that a nucleated red blood cell (NRBC) count ≥26 per 100 white blood cells (%) or the development of a platelet count ≤100 000 per mm3 within five days of birth is characteristic of neonates who have experienced acute birth asphyxia. Study design. Study cases were from the population defined in a prior publication (Prenat Neonat Med 1997;2:286). The impaired neonates were separated into three groups: group 1, persistent non-reactive fetal heart rate (FHR) pattern from admission until delivery; group 2, reactive FHR pattern on admission followed by a tachycardia, non-reactivity, repetitive variable or late decelerations, and usually a loss of variability; group 3, cases with a reactive FHR pattern on admission followed by a sudden, rapid and sustained deterioration of the FHR usually in response to a hypoxic sentinel event that lasted until delivery or a bradycardia on admission. The FHR pattern in group 3 is considered most consistent with acute birth asphyxia. We then examined these FHR groups with respect to the presence of hematologic injury. Chi-square testing was used to describe differences among the study populations. Results. Of the original 52 cases, sufficient hematologic data were available for 47. Of these, the proportion of cases with NRBC ≥26% was: group 1, 10/21 (47.6%); group 2, 0/14 (0%); group 3, 0/12 (0%). Those with a platelet count ≤100 000 per mm3: group 1, 11/21 (52.4%); group 2, 2/14 (14.3%); group 3, 0/12 (0%). Group 1 was significantly more likely to have an NRBC count ≥26% than group 3 (p = 0.0135). A platelet count ≤100 000 per mm3 within five days of birth was also significantly more likely to be encountered in group 1 as compared with group 3 (p = 0.0072). Conclusion. In cases of acute birth asphyxia, hematologic injury was infrequently encountered. Our findings suggest that a neonatal NRBC count ≥26% and/or a platelet count ≤100 000 per mm3 within five days of birth is inconsistent with acute birth asphyxia.

Fetal heart rate patterns in 423 brain-damaged infants: an update

Objective: To update our experience with the fetal heart rate (FHR) pattern of singleton term brain-damaged infants. Methods: The FHR patterns of 123 singleton term brain-damaged infants were retrospectively analyzed and compared with 300 previously published cases. Results: For these 423 cases, obstetrical care was provided from 1976 to 1998. With the exception of more recent obstetrical care, the additional 123 cases were statistically similar to the previously published 300 cases. Overall, the admission FHR patterns were reactive: 229 (54%); nonreactive: 175 (41%); bradycardic: 10 (3%); or unclassifiable: 9 (2%). In the reactive group, the FHR did the following: 1) remained reactive: 29 (13%); 2) developed an elevated baseline in association with repetitive decelerations: 107 (47%); or 3) exhibited a sudden prolonged FHR deceleration that lasted until delivery: 93 (40%). In the nonreactive group, the FHR pattern remained nonreactive at a similar baseline rate: 125 (71%); developed a progressive bradycardia: 32 (18%); or developed a prolonged deceleration that lasted until delivery: 18 (10%). Conclusion: Our retrospective review of 123 additional cases continues to demonstrate that brain-damaged fetuses manifest distinctly similar intrapartum FHR patterns that easily can be categorized and identified on the basis of the fetal admission test and subsequent changes in the baseline rate. This distinction, which covers a 22-year period, would appear to be helpful in the management of obstetrical patients in labor.