Journal of perinatal medicine · 2025
The incidence and outcomes of perinatal asphyxia in spontaneous extreme preterm birth: a retrospective cohort study.
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Faiz Zohal, van 't Hof Eline, de Boer Marjon, de Haan Timo R, Weissenbruch Mirjam, Klautz Arthur, Lippes Pien, Mol Ben Willem, de Groot Christianne, Bakker Petra
Аннотация
OBJECTIVES: To determine the incidence and outcome of perinatal asphyxia (PA) in spontaneous extreme preterm birth (PTB) between 24 and 28 weeks gestation.
METHODS: We conducted a retrospective cohort study (2010-2019) at a Dutch tertiary center, including singleton spontaneous PTBs with active neonatal management. PA was defined as a 5-min Apgar score ≤5, umbilical artery pH≤7.00, base deficit >12 mmol/L, and need for ongoing resuscitation. Cases were classified as proven PA (all criteria met), suspected PA (Apgar≤5 only if blood gas data missing), or no PA. Neurodevelopment was assessed at 2 years corrected age. Multiple imputation addressed missing data. Logistic regression, adjusted for gestational age (GA), was used to evaluate associations with infant mortality, cerebral injury, and neurodevelopmental impairment (NDI).
RESULTS: Among 138 neonates, 84 % had no PA, 12.3 % suspected PA, and 3.6 % proven PA. After imputation, the estimated incidence of PA was 5.0 %. PA was not significantly associated with infant mortality (aOR 1.07; 95 % CI 0.13-8.87; p=0.95) or intraventricular hemorrhage (aOR 1.62; 95 % CI 0.26-10.39; p=0.61). NDI occurred in two infants with PA.
CONCLUSIONS: PA occurred more frequently in this extreme preterm cohort than in term neonates, yet did not independently influence mortality or morbidity. A major limitation is the use of ACOG criteria, originally developed for term births, which may have led to over- or underestimation of PA's true incidence and impact. Although based on few confirmed cases, findings suggest PA, may not be a major independent predictor of adverse outcome in extreme PTB.
METHODS: We conducted a retrospective cohort study (2010-2019) at a Dutch tertiary center, including singleton spontaneous PTBs with active neonatal management. PA was defined as a 5-min Apgar score ≤5, umbilical artery pH≤7.00, base deficit >12 mmol/L, and need for ongoing resuscitation. Cases were classified as proven PA (all criteria met), suspected PA (Apgar≤5 only if blood gas data missing), or no PA. Neurodevelopment was assessed at 2 years corrected age. Multiple imputation addressed missing data. Logistic regression, adjusted for gestational age (GA), was used to evaluate associations with infant mortality, cerebral injury, and neurodevelopmental impairment (NDI).
RESULTS: Among 138 neonates, 84 % had no PA, 12.3 % suspected PA, and 3.6 % proven PA. After imputation, the estimated incidence of PA was 5.0 %. PA was not significantly associated with infant mortality (aOR 1.07; 95 % CI 0.13-8.87; p=0.95) or intraventricular hemorrhage (aOR 1.62; 95 % CI 0.26-10.39; p=0.61). NDI occurred in two infants with PA.
CONCLUSIONS: PA occurred more frequently in this extreme preterm cohort than in term neonates, yet did not independently influence mortality or morbidity. A major limitation is the use of ACOG criteria, originally developed for term births, which may have led to over- or underestimation of PA's true incidence and impact. Although based on few confirmed cases, findings suggest PA, may not be a major independent predictor of adverse outcome in extreme PTB.