Correlation between fetal heart rate reactivity and mortality and severe neurological morbidity in extremely low birth weight infants

Abstract

Objective: To determine the correlation between specific fetal heart rate (FHR) abnormalities and the incidence of death, severe (grade 3–4) intraventricular hemorrhage (IVH) and periventricular echogenicity (PVE) in extremely low birth weight infants (ELBW) within the first 4 days after birth. Methods: The study included live-born ELBW infants ≤ 30 weeks’ gestation who were born in 2000–2007 at Kaplan Medical Center, Rehovot, Israel, and, who had FHR monitoring during the 24 h before delivery and cranial ultrasound during the first 4 days of life. FHR pattern was analyzed for the presence of baseline rate, reactivity, variability and decelerations. Results: 96 infants with mean birth weight 757 ± 150 g and mean gestational age 25.8 ± 1.5 weeks were included. By 4 days of life, 23/96 (24%) died, 17/96 (18%) developed severe IVH and 31/96 (32%) had PVE. Absence of reactivity was significantly associated with increase in both death (p = 0.02, OR 3.45, 95% CI: 1.22–9.47 and severe IVH (p = 0.029, OR 3.33, 95% CI: 1.25–10) but not with PVE. Other FHR parameters were not associated with adverse outcome. Conclusion: These results suggest that FHR reactivity may be of value in predicting short-term outcome in ELBW infants. This may be helpful in counseling parents with imminent extremely preterm birth.