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

Abstract

ObjectiveTo investigate the association between hypoxic‐ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP).DesignLongitudinal study.SettingDatabase of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy.SampleInfants with severe CP born at ≥34 weeks of gestation.MethodsThe 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.Main outcome measuresManifestations of the brain MRI types and the association between FHR evolution pattern and MRI type were analysed.ResultsAmong 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.ConclusionBGT‐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.Tweetable abstractBasal ganglia‐thalamus injury constitutes 76% of severe cerebral palsy cases, predominant even in antenatal‐onset cases.