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Am J Perinatol 2007; 24(2): 083-088
DOI: 10.1055/s-2006-958161
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Fetal Heart Rate Accelerations and the Risk of Cerebral Lesions and Poor Neurodevelopmental Outcome in Very Low Birthweight Neonates

Emanuel J. Vlastos1 , 2 , Tracy M. Tomlinson1 , 2 , Ibrahim Bildirici1 , 2 , Sreedevi Sreenarasimhaiah1 , 2 , Kamran Yusuf3 , Yoel Sadovsky1 , 2 , Roni Levy1 , 2
  • 1Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
  • 2Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri
  • 3Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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Publication History

Publication Date:
29 January 2007 (online)

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ABSTRACT

The risk of intraventricular hemorrhage and periventricular leukomalacia correlates with fetal brain immaturity. Given that the appearance of fetal heart rate (FHR) accelerations is associated with brain maturation, we tested the hypothesis that neonatal cerebral lesions and developmental delay in very low birthweight newborns are associated with absent reactivity of the FHR tracing prior to delivery. We analyzed the FHR tracing of 97 fetuses with birthweight < 1200 g who underwent head ultrasound at day 3 and Bayley Scales of Infant Development testing at age 1 year. We used multivariate analysis to adjust for confounding variables. We found that the absence of two FHR accelerations of 10 beats per minute (bpm) for 10 seconds twice in a 20-minute window 1 hour before delivery was associated with intraventricular hemorrhage and/or periventricular leukomalacia (p < 0.01) and a significant risk for mental and psychomotor delays by Bayley testing (p < 0.001). The absence of accelerations of 15 bpm for 15 seconds was not associated with these abnormalities. The absence of FHR accelerations before delivery suggests a greater risk for cerebral injury and developmental delay in the very premature neonate.

KEYWORDS

Fetal heart rate - intraventricular hemorrhage - periventricular leukomalacia - Bayley Scales of Infant Development

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Tracy M TomlinsonM.D. 

Washington University, Department of OBGYN-Campus Box 8064

4566 Scott Avenue, St. Louis, MO 63110