The relationship between clinically identifiable intrapartum sentinel events and short-term outcome after therapeutic hypothermia

Objective: To determine the impact of intrapartum sentinel events on short-term outcome post-hypothermia. Study design: Records of 77 infants of 36 weeks' gestation or more, who received therapeutic hypothermia, were reviewed. Some were delivered after a clinically identifiable intrapartum sentinel event (IISE). All survivors had brain magnetic resonance imaging (MRI) at 7 to 10 days of life. The primary outcome of neonatal death related to hypoxic-ischemic encephalopathy was compared in infants born with (n = 39) or without an IISE (n = 38). MRI abnormalities were also compared. Logistic regression analysis was used to determine the variables predicting the primary outcome. Results: The two groups had similar Apgar scores, initial blood pHs, and early neurologic examinations. Base deficit was more severe in the IISE group. Neonatal death and hypoxic-ischemic injury was shown on brain MRI with basal nuclei, cortical, and subcortical white matter lesions extending beyond the watershed areas in infants surviving beyond the neonatal period were more common in the IISE group (P =.014; OR 11.1; 95% CI 1.3-92.6; and P =.034; OR 4.1; 95% CI 1.1-14.9, respectively). Multivariate analysis identified IISE (P =.023; OR 12.2; 95% CI 1.4-105.8) to be independently associated with neonatal death. Conclusions: IISEs are associated with neonatal death and severe injury as shown in brain MRI, even after hypothermia.