Neurodevelopmental outcome and electronic fetal heart rate monitoring in a neonatal intensive care population.

Abstract

In a one-year population, 1977, of newborn infants admitted to the Neonatal Intensive Care Unit (NICU) the incidence of persistent neurodevelopmental handicaps was 3%, i.e. 13 of 427 survivors at 2 years of age. Transient abnormalities during the first 6 months of life were found in 63 infants, but after 6 months of age they were all normal at follow-up examinations. Most mothers with infants showing transient abnormalities or persistent handicaps had a high-risk pregnancy but one-third (35.5%) had a low-risk pregnancy and in this group 4 out of 7 cases with persistent major neurodevelopmental handicaps were found. In the total one-year population, 6% showed ominous fetal heart rate patterns (FHR) in labor compared with 31% of infants with later abnormalities and handicaps. Furthermore, all 13 infants with persistent handicaps had a normal Apgar score at 5 min, indicating that Apgar scoring was less predictive than FHR for neurodevelopmental outcome. Altogether 54 infants born in 1977 were small for gestational age (SGA): 33 NICU-treated and 21 not NICU-treated. Seven (6 NICU-treated, 1 not NICU-treated) had transient abnormalities (12.9%). No SGA infant developed persistent handicaps. The results suggest an improved obstetric and neonatal care of these infants.