CLUSTERING OF PERINATAL MARKERS OF BIRTH ASPHYXIA AND OUTCOME AT AGE 5 YEARS

Objectives In a cohort of term infants with cerebral depression at del ivery, to investigate the association of perinatal signs of birth asph yxia, particularly abnormal fetal heart rate patterns in labour, acida emia, and serious neonatal encephalopathy, with neurodevelopmental out come at age five years. Design Five year follow up study of a birth co hort. Setting Regional maternity hospital. Subjects One hundred and ei ghty-four singleton infants with a 1 min Apgar score less than or equa l to 3, born at term between January 1984 and September 1985. Main out come measures Neonatal death, cerebral palsy, and scores on a battery of neurodevelopmental tests at age five. Results Seven infants had a c luster of perinatal signs suggestive of birth asphyxia; all included s erious neonatal encephalopathy. Three of these infants died neonatally , three had spastic quadriparesis with profound developmental delay, a nd one was unimpaired at the age of five. Among the remaining infants, no association was found between severely abnormal fetal heart rate p atterns in labour and scores on neurodevelopmental tests, or between a cid-base status at delivery and test scores. Conclusions Birth asphyxi a, identified by a cluster of abnormal perinatal signs, including seri ous neonatal encephalopathy, has a poor prognosis. If serious encephal opathy is not present, cerebral depression at birth preceded by abnorm al fetal heart rate patterns in labour, or with acid-base derangement, is not predictive of later impairment.