Predicting asphyxia in term fetus

Figures & data

Table 1. The definition criteria of neonatal asphyxia.

1. Does the baby meet the definition of HIE? 35+ weeks gestation, abnormal consciousness±difficulty initiating and maintaining respiration, seizures, abnormal tone/reflexes

2. What is the likelihood that an acute peripartum or intrapartum event was the major contributor?

Neonatal signs:

a. Apgar score of less than five at 10 min of life

b. Fetal umbilical artery acidemia: pH <7 or base deficit ≥12

c. MRI obtained between 24 and 96 h and up to day 10 showing distinct basal-ganglia thalamus, watershed, or near-total cortical injury pattern

d. Presence of multisystem organ failure – can include cardiac, renal, hepatic, metabolic, hematologic and gastrointestinal dysfunction

Type and timing of contributing factors consistent with an acute or peripartum event

a. Sentinel hypoxic or ischemic event immediately before or during labor/delivery: e. g., ruptured uterus, umbilical cord prolapse

b. Fetal heart rate pattern that deteriorates to absent variability with recurrent late or variable decelerations, or with bradycardia, or a sinusoidal pattern for ≥20 min

c. MRI obtained between 24 and 96 h and up to day 10 showing distinct basal-ganglia thalamus or watershed pattern

d. No evidence of other proximal or distal factors that could contribute substantially or indicate other underlying pathobiology, e.g. abnormal fetal growth, congenital microcephaly, maternal infection, neonatal sepsis

The developmental outcome is spastic quadriplegic or dyskinetic cerebral palsy (CP)

a. Other CP subtypes are less likely to be associated with an acute peripartum or intrapartum event, and spastic quadriplegia and dyskinesia can also have other causes.

b. Other developmental disabilities may occur but are not specific to acute peripartum or intrapartum events and may arise from various causes.

Table 2. Hematological parameters according to the study groups.

	Mean±SD
Parameter	Asphyxia	Normal	p
Hemogram (g/dL)	11.73 ± 1.63	11.81 ± 1.48	NS
Hematocrit (%)	35.56 ± 4.40	35.49 ± 3.71	NS
MCV (fL)	83.05 ± 23.19	81.05 ± 7.38	NS
RDW (%)	14.15 ± 2.74	15.05 ± 2.32	NS
PCT	0.25 ± 0.10	0.27 ± 0.07	NS
PDW	17.09 ± 3.97	14.00 ± 2.93	.000*
Neutrophil count(10³/μL)	8.93 ± 3.48	8.61 ± 2.79	NS
Lymphocyte count (10³/μL)	2.32 ± 0.77	2.26 ± 0.72	NS
Basophil count (10³/μL)	0.07 ± 0.08	0.03 ± 0.03	.000*
Eisonophil count (10³/μL)	0.09 ± 0.12	0.09 ± 0.09	NS
Platelet count (10³/μL)	246.50 ± 74.18	249.17 ± 71.53	NS
Neutrophil/lymphocyte ratio	4.36 ± 3.02	4.28 ± 2.49	NS
Platelet/lymphocyte ratio	0.11 ± 0.06	0.12 ± 0.04	NS

Notes: NS: not statistically significant (p ≥ .05). *p<.05

PDW predicts asphyxia better than basophil count; the area under the curve was 0.72 and 0.67, respectively (Table 3).

Table 3. Area under the curve for PDW and basophil for asphyxia group.

Test result variable	Area	Standard error	Asymptotic sig.470:84	Asymptotic 95% confidence interval
				Lower bound/upper bound
PDW	.724	.033	.000	.659	.789
Basophil	.674	.034	.000	.607	.741

Note: Asphyxia’s PDW and basophil count cut-off points were 19.425 and 0.15 (10³/μL), respectively.

Figure 1. ROC curve for PDW and basophil count in fetal asphyxia.