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

Masahiro Nakao; Yukiko Nanba; Asumi Okumura; Junichi Hasegawa; Satoshi Toyokawa; Kiyotake Ichizuka; Naohiro Kanayama; Shoji Satoh; Nanako Tamiya; Akihito Nakai; Keiya Fujimori; Tsugio Maeda; Hideaki Suzuki; Mitsutoshi Iwashita; Akira Oka; Tomoaki Ikeda

doi:10.1111/1471-0528.17089

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

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

Authors

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

¹ The Recurrence Prevention Committee, The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.
² Department of Obstetrics and Gynaecology, Mie University Graduate School of Medicine, Tsu, Japan.
³ Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan.
⁴ Department of Paediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan.
⁵ Department of Obstetrics and Gynaecology, St. Marianna University School of Medicine, Kawasaki, Japan.
⁶ Department of Public Health, The University of Tokyo, Tokyo, Japan.
⁷ Department of Obstetrics and Gynaecology, Showa University Northern Yokohama Hospital, Yokohama, Japan.
⁸ Department of Obstetrics and Gynaecology, Hamamatsu University School of Medicine, Shizuoka, Japan.
⁹ Maternal and Perinatal Care Centre, Oita Prefectural Hospital, Oita, Japan.
¹⁰ Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
¹¹ Department of Obstetrics and Gynaecology, Nippon Medical School, Tokyo, Japan.
¹² Department of Obstetrics and Gynaecology, Fukushima Medical University, Fukushima, Japan.
¹³ Maeda Clinic, Incorporated Association Anzu-kai, Shizuoka, Japan.
¹⁴ The Japan Obstetric Compensation System for Cerebral Palsy, Japan Council for Quality Health Care, Tokyo, Japan.
¹⁵ Kugayama Hospital, Tokyo, Japan.
¹⁶ Department of Paediatrics, Saitama Children's Medical Centre, Saitama, Japan.

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.

MeSH terms

Bradycardia / complications
Cerebral Palsy* / diagnostic imaging
Female
Heart Rate, Fetal
Humans
Hypoxia-Ischemia, Brain* / diagnostic imaging
Infant
Longitudinal Studies
Magnetic Resonance Imaging / methods
Placenta / pathology
Pregnancy
Stroke*