Comparison of intrapartum fetal heart rate tracings in patients with neonatal seizures vs. no seizures: what are the differences?

Objective: To determine which intrapartum fetal heart rate parameters in the presence of severe neonatal acidosis (pH<7.0) appropriately predicts the development of neonatal seizures in the context of hypoxic ischemic encephalopathy (HIE). Methods: The intrapartum fetal heart rate tracings of 25 neonates who developed neonatal seizures secondary to HIE were compared with 25 matched neonates with similar pH and gestational age who did not develop seizures. All patients had at least 2 hours of intrapartum fetal heart rate patterns available for review. We compared the fetal heart rate parameters of prolonged deceleration, variable and late decelerations, variability, accelerations, fetal heart rate baseline and duration of the fetal heart rate abnormality. Comparison between the groups was done using chisquare for nominal data and student ttests for continuous data. Results: Neonates with seizures 2 HIE had a significantly longer duration of abnormal fetal heart rate patterns (72 +/- 12 minutes vs 48 +/- 12 minutes, p<0.001). Discussion: This study demonstrated that in the setting of neonatal acidosis the development of seizures is related to the period of stress (duration of the abnormal fetal heart rate pattern).