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. 2022 Aug;129(9):1574-1582.
doi: 10.1111/1471-0528.17089. Epub 2022 Feb 13.

Correlation between fetal heart rate evolution patterns and magnetic resonance imaging findings in severe cerebral palsy: A longitudinal study

Masahiro Nakao  1   2   3 , Yukiko Nanba  1   4 , Asumi Okumura  1   2 , Junichi Hasegawa  1   5 , Satoshi Toyokawa  1   6 , Kiyotake Ichizuka  1   7 , Naohiro Kanayama  1   8 , Shoji Satoh  1   9 , Nanako Tamiya  1   10 , Akihito Nakai  1   11 , Keiya Fujimori  1   12 , Tsugio Maeda  1   13 , Hideaki Suzuki  1   14 , Mitsutoshi Iwashita  1   15 , Akira Oka  1   16 , Tomoaki Ikeda  1   2
Affiliations

Correlation between fetal heart rate evolution patterns and magnetic resonance imaging findings in severe cerebral palsy: A longitudinal study

Masahiro Nakao et al. BJOG. 2022 Aug.

Abstract

Objective: To investigate the association between hypoxic-ischaemic insult timing and brain injury type in infants with severe cerebral palsy (CP).

Design: Longitudinal study.

Setting: Database of the Recurrence Prevention Committee, Japan Obstetric Compensation System for Cerebral Palsy.

Sample: Infants with severe CP born at ≥34 weeks of gestation.

Methods: The intrapartum fetal heart rate (FHR) strips were categorised as continuous bradycardia; persistently non-reassuring (NR-NR); reassuring-prolonged deceleration (R-PD); Hon's pattern (R-Hon); persistently reassuring (R-R); and unclassified. The brain magnetic resonance imaging (MRI) scans were categorised based on the predominant site involved: basal ganglia-thalamus (BGT); white matter (WM); watershed (WS); stroke; normal; and unclassified.

Main outcome measures: Manifestations of the brain MRI types and the association between FHR evolution pattern and MRI type were analysed.

Results: Among 672 eligible infants, 76% had BGT-dominant injury, 5.4% WM, 1.2% WS, 1.6% stroke, 1.9% normal, and 14% unclassified. Placental abruption and small-for-gestational age were associated with an increased (adjusted odds ratio [aOR] 8.02) and decreased (aOR 0.38) risk of BGT injury, respectively. The majority of infants had BGT injury in most FHR groups (bradycardia, 97%; NR-NR, 75%; R-PD, 90%; R-Hon, 76%; and R-R, 45%). The risk profiles in case of BGT in the NR-NR group were similar to those in the R-PD and R-Hon groups.

Conclusion: BGT-dominant brain damage accounted for three-fourths of the cases of CP in term or near-term infants, even in prenatal onset cases. Hypoxic-ischaemic insult has a major impact on CP development during the antenatal period.

Tweetable abstract: Basal ganglia-thalamus injury constitutes 76% of severe cerebral palsy cases, predominant even in antenatal-onset cases.

Keywords: basal ganglia; brain injuries; cardiotocograph; cerebral palsy; hypoxia-ischaemia; infant; perinatal; thalamus.

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Conflict of interest statement

None declared. Completed disclosure of interest forms are available to view online as supporting information.

Figures

FIGURE 1
FIGURE 1
Analysis of fetal heart rate evolution pattern and infant brain MRI. (A) Analysis of fetal heart rate evolution pattern. NR‐NR, decreased variability on admission; R‐Hon, gradual deterioration followed by a decline in base rate; R‐PD, reassuring on admission and abruptly changed immediately before delivery; R‐R, fetal heart rate variability maintained throughout delivery. (B) Analysis of magnetic resonance imaging. BGT, basal ganglia‐thalamus
FIGURE 2
FIGURE 2
Profile of risk factors in each FHR class stratified by BGT injury, WS‐WM injury and remainder categories. Risk profiles of BGT injury in the NR‐NR (antenatal cause suspected) group were similar to those in the intrapartum causal groups (R‐PD and the R‐Hon groups), that is, umbilical abnormalities, intrauterine infection, placental abruption and SGA, in that order. BGT, basal ganglia‐thalamus; FHR, fetal heart rate; NR‐NR, decreased variability on admission; R‐Hon, gradual deterioration followed by decline in base rate; R‐PD, reassuring on admission and abruptly changed immediately before delivery; R‐R, fetal heart rate variability maintained throughout delivery; SGA, small‐for‐gestational age; WS‐WM, watershed‐white matter
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