Hypoxic Ischaemic Encephalopathy (HIE) is rare in the developed world. HIE is characterised by the development of evidence of perinatal brain injury caused by reduced cerebral perfusion and/or hypoxia. This leads to the development of neonatal irritability, seizures and in some cases death. 30-40% of babies who develop moderate or severe HIE will develop cerebral palsy.
There is a recognised association between obstetric emergencies such as shoulder dystocia, abruption and cord prolapse. However, the role of infection and inflammation is not yet established. We identified 9 cases of HIE and reviewed maternal intrapartum and post partum investigations that might suggest infection or sepsis.
All women delivered after their first labour. Eight women were nulliparous and one woman had been delivered by Caesarean section in her previous pregnancy. Of the babies, 8/9 were singletons, and 1/9 was a second twin.
Four of nine cases were identified as having fever >37.3 in intrapartum period or in the first 6 hours post delivery. In 3/9 cases Group B Streptococcus was detected in vaginal and placental cultures. In 5/9 cases placental histology was available. Of these cases, 4/5 demonstrated funisitis. 4/5 demonstrated acute chorioamnionitis.
There are data which report increased circulating cytokines in neonates born with HIE which may suggest a role for infection.1 These cases demonstrate further evidence of a link between neonatal brain injury and neonatal infection.
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