TY - JOUR
T1 - Electronic fetal monitoring patterns associated with respiratory morbidity in term neonates
AU - Liu, Lucy
AU - Tuuli, Methodius G.
AU - Roehl, Kimberly A.
AU - Odibo, Anthony O.
AU - Macones, George A.
AU - Cahill, Alison G.
N1 - Funding Information:
Supported in part by the National Institute of Child Health and Human Development ( R01HD061619-01 ; A.G.C., who also received funding as a Robert Wood Johnson Faculty Physician Scholar).
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/11
Y1 - 2015/11
N2 - Objective The purpose of this study was to identify electronic fetal monitoring patterns that are associated with neonatal respiratory morbidity. Study Design In an on-going prospective cohort study of >8000 consecutive term, vertex, nonanomalous singleton pregnancies during labor, we performed this analysis within the first 5000 women as a representative sample. Electronic fetal monitoring patterns in the 30 minutes preceding delivery were extracted by trained obstetrics research nurses, who were blinded to clinical data, using the National Institute of Child Health and Human Development system; the data were compared between those with respiratory morbidity and healthy infants (no morbidities). The primary outcome was neonatal respiratory morbidity, which was defined as either oxygen requirement at ≥6 hours of life or any mechanical ventilation in the first 24 hours. Multivariable logistic regression was used to adjust for confounders. Results Of 4736 neonates, 175 (3.4%) experienced respiratory morbidity. Most electronic fetal monitoring patterns were category II (96.6%; n = 4575). Baseline tachycardia (adjusted odds ratio [aOR], 2.9; 95% confidence interval [CI], 1.9-4.4), marked variability (aOR, 2.7; 95% CI, 1.5-5.0), and prolonged decelerations (aOR,2.7; 95% CI, 1.5-5.0) were significantly associated with an increased likelihood of term neonatal respiratory morbidity. Accelerations and persistent moderate variability were both significantly associated with a decreased likelihood of respiratory morbidity. Conclusion Specific features of category II electronic fetal monitoring patterns make respiratory morbidity more likely in nonanomalous term infants. Tachycardia, marked variability, or prolonged decelerations before delivery can assist providers in anticipating the potential need for neonatal respiratory support.
AB - Objective The purpose of this study was to identify electronic fetal monitoring patterns that are associated with neonatal respiratory morbidity. Study Design In an on-going prospective cohort study of >8000 consecutive term, vertex, nonanomalous singleton pregnancies during labor, we performed this analysis within the first 5000 women as a representative sample. Electronic fetal monitoring patterns in the 30 minutes preceding delivery were extracted by trained obstetrics research nurses, who were blinded to clinical data, using the National Institute of Child Health and Human Development system; the data were compared between those with respiratory morbidity and healthy infants (no morbidities). The primary outcome was neonatal respiratory morbidity, which was defined as either oxygen requirement at ≥6 hours of life or any mechanical ventilation in the first 24 hours. Multivariable logistic regression was used to adjust for confounders. Results Of 4736 neonates, 175 (3.4%) experienced respiratory morbidity. Most electronic fetal monitoring patterns were category II (96.6%; n = 4575). Baseline tachycardia (adjusted odds ratio [aOR], 2.9; 95% confidence interval [CI], 1.9-4.4), marked variability (aOR, 2.7; 95% CI, 1.5-5.0), and prolonged decelerations (aOR,2.7; 95% CI, 1.5-5.0) were significantly associated with an increased likelihood of term neonatal respiratory morbidity. Accelerations and persistent moderate variability were both significantly associated with a decreased likelihood of respiratory morbidity. Conclusion Specific features of category II electronic fetal monitoring patterns make respiratory morbidity more likely in nonanomalous term infants. Tachycardia, marked variability, or prolonged decelerations before delivery can assist providers in anticipating the potential need for neonatal respiratory support.
KW - electronic fetal monitoring
KW - neonatal respiratory morbidity
KW - term neonate
UR - http://www.scopus.com/inward/record.url?scp=84946501085&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2015.07.013
DO - 10.1016/j.ajog.2015.07.013
M3 - Article
C2 - 26193688
AN - SCOPUS:84946501085
VL - 213
SP - 681.e1-681.e6
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
SN - 0002-9378
IS - 5
ER -