156: Clinical management of deliveries resulting in hypoxic ischemic encephalopathy

Neonatal encephalopathy (HIE), while rare, can result in devastating lifelong neurologic injury. Details on clinical management for deliveries resulting in HIE are limited. Our aim was to characterize intrapartum conditions and management leading to delivery of neonates with HIE. Neonates with HIE based on cord gas pH < 7.0 or base excess of ≥12 along with relevant radiological, laboratory, and clinical findings who were delivered at ≥35 weeks gestation at 3 large academic medical centers from 2007 to 2016 were identified. Clinical management was characterized through chart review based on labor course, fetal heart rate (FHR) tracing on presentation and the final 30 minutes before delivery, mode of delivery, the presence of sentinel events, and time to delivery. Of 144,904 deliveries over the study period, 102 women and corresponding neonates met criteria and were included. 11.8% of pregnancies were complicated by diabetes, 6.9% by chronic hypertension, 10.8% by preeclampsia, and 8% by smoking. 44.1% of women were white, 26.4% black, and 27.5% were Hispanic. Of the 102 women, 19 were delivered within 120 minutes of presentation (Figure 1). 4 subsequently experienced a sentinel event and were delivered emergently. 83.5% of the remaining deliveries (66/79) had moderate variability or accelerations on presentation. In the 30 minutes prior to delivery, 41.1% (27/66) of cases had moderate variability or accelerations; 59% of these cases had cesarean deliveries. Of the 39 cases that did not have reassuring features, 36.2% had cesarean deliveries (Figure 2). Approximately 2/3 of cases of HIE in this series occurred in the setting of initially reassuring FHR characteristics without a sentinel event. Of those cases that had variability and/or accelerations on presentation >40% retained these reassuring features until delivery. The group with reassuring features had a higher cesarean rate than those without. These findings suggest that to further improve outcomes, additional insights are required to identify and mitigate risk for HIE in the setting of reassuring monitoring.View Large Image Figure ViewerDownload Hi-res image Download (PPT)