Neurodevelopmental Outcome of Severe Acidemic Term Infants

Abstract

Objective: This study aimed to evaluate the perinatal factors associated with neonatal mortality and neurologic morbidity in term infants with severe acidosis. Methods: We retrospectively reviewed the data of term infants with severe acidosis from January 2012 to December 2016. Severe acidosis was defined as initial pH of less than <7.0 and base excess ≥-12 mmol/L. We searched the clinical characteristics, morbidities of mother and infants, and neuroimaging results. Also infants were divided by neurodevelopmental impairment and evaluated the relating perinatal factors. Results: Twenty three term infants had severe acidosis. Meconium stained amniotic fluid was found in 43.5% and neonatal resuscitation with positive pressure ventilation and endotracheal intubation was needed in 43.5% and 26.1%. Among 8 infants with hypoxic-ischemic encephalopathy (HIE), stage 2 or higher were 87.5%. Four infants (17.4%) showed abnormal brain imaging taken before discharge. On the analysis, the longer duration of invasive mechanical ventilation (P=0.049) and increased need for gavage feeding (P=0.021) were found in neurodevelopment impairment group. Conclusion: The presence of HIE and abnormal findings of brain imaging before discharge were found to be associated with abnormal neurodevelopmental outcome in term infants with severe acidosis. Even if the brain imaging test was normal, we should consider the long-term follow-up of severe acidemic term infants.