Antepartum and Intrapartum Characteristics Associated With Neonatal Encephalopathy [ID 2683510

Abstract

INTRODUCTION: We aim to identify antepartum and intrapartum characteristics associated with neonatal encephalopathy (NE). METHODS: This is a retrospective cohort study from 2013 to 2023. Neonates greater than 34–35 weeks of gestation with NE were identified based on ICD-9/ICD-10 codes. Each case was matched to three controls. Neonates (>34–35 weeks of gestation, cord pH >7, no NE) next to index case were identified as controls. Congenital anomalies, chromosomal abnormalities, and less than 34 weeks were excluded. The outcome measures are incidence and trends of NE in last 10 years and antepartum and intrapartum risk factors associated with NE. This study was IRB approved. RESULTS: Twenty cases were included and matched with 60 controls. The number of cases increased since 2013. 1 in 6,000 neonates delivered was identified as NE in 2014, versus 4 of the 5,700 births in 2016, versus 3 of the 2,114 neonates delivered in 2023. Mean maternal age, race/ethnicity/insurance are similar between groups. Cases are more likely to have obesity class 3 (P=.05) and nulliparous (P=.01), class A2 gestational diabetes mellitus (GDMA2) (P=.05), preterm prelabor rupture of membranes (PPROM) (P=.0.01), and tobacco use (P=.00). There is statistically significant difference in Category 3 fetal heart tracing (P=.00), meconium (P=.03), placental abruption (P=.00), and general anesthesia (P=.00) between groups. Mode of delivery, breech, shoulder dystocia cord prolapse, chorioamnionitis, uterine rupture, amniotic fluid embolism, and maternal cardiovascular collapse were similar between groups. Gestational age at delivery, birth weight, and gender were similar between groups. CONCLUSION: The risk factors associated with NE in our study are obesity class 3, nulliparity, tobacco use, GDMA2, PPROM, Category 3 tracing, meconium, and placental abruption.