Delivery | Case no 1 | Case no 2 | Case no 3 | Case no 4 | Case no 5 | Case no 6 | Case no 7 | Case no 8 | Case no 9 | Case no 10 | ||
SVD | Instrumental | Em LSCS | Instrumental | Instrumental | Em LSCS | SVD | Instrumental | Em LSCS | Em LSCS | |||
Type of admission | Outborn | Outborn | Outborn | Inborn | Outborn | Outborn | Outborn | Outborn | Inborn | Inborn | ||
Gestational age (weeks+days) | 41+2 | 39+0 | 40+3 | 36+5 | 42+1 | 41+2 | 40+3 | 40 | 37 | 41 | ||
Birth weight (g (centile)) | 3200 (9–25) | 4530 (98–99) | 4055 (75–91) | 3470 (91–98) | 4260 (75–91) | 3742 (50–75) | 3630 (50–75) | 2990 (9) | 2640 (25–50) | 3908 (75–91) | ||
Cardiotocography | Late deceleration | Normal | Bradycardia | Tachycardia | Bradycardia | Variable deceleration | Bradycardia | Variable deceleration | Bradycardia | Bradycardia | ||
Arterial cord pH | 7.2 | 7.3 | 6.8 | 7.1 | 7.1 | 6.9 | 7.2 | 7.1 | 6.9 | NA | ||
Arterial cord base excess | −10.1 | −7.6 | Incalculable | −7.9 | −8.5 | −15.7 | −9.2 | −9.5 | −14.7 | NA | ||
Arterial cord pCO2 | 5.43 | 5.56 | 16.2 | 8.5 | 8.7 | NA | 5.33 | 7.36 | 12.8 | NA | ||
pH on first blood gas | 7.2 | 6.8 | 7.02 | 7.3 | 7.2 | 7.1 | 6.9 | 6.9 | 7.14 | 7.05 | ||
Base excess on first blood gas | −11.3 | −10.2 | −13.7 | −5.6 | −6.8 | −9.1 | −8.2 | NA | −5.2 | −13.2 | ||
pCO2 on first blood gas | 5.13 | NA | 7.02 | 5.5 | 6 | 5.2 | 13.7 | NA | 9.4 | NA | ||
Apgar 1 min | 7 | 0 | 2 | 1 | 4 | 5 | 4 | 3 | 3 | 1 | ||
Apgar 5 min | 7 | 0 | 3 | 4 | 8 | 6 | 6 | 6 | 8 | 4 | ||
Apgar 10 min | 6 | 0 | 4 | 6 | 10 | 7 | 9 | 8 | 8 | NA | ||
Resuscitation at birth | Intubation | Intubation+ECM | Intubation | Intubation+ECM | Bag and mask | Bag and mask | Bag and mask | Bag and mask | Bag and mask | Intubation | ||
Complications at birth | None | Shoulder dystocia | Failure to progress | Shoulder dystocia | None | MAS | Cord around the neck | Failure to progress | None | MAS | ||
Inotropic support at admission | No | No | Yes | No | No | Yes | No | Yes | No | Yes | ||
Postrewarming inotropic support | No | No | Yes | No | No | Yes | No | Yes | No | Yes | ||
Neurological examination at admission* 0=normal 1=mild 2=moderate 3=severe | LOC | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 2 | |
Spontaneous activity | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 2 | 1 | ||
Posture | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 0 | ||
Tone | 2 | 2 | 2 | 1 | 2 | 1 | 1 | 0 | 1 | 0 | ||
Reflexes | Moro | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | |
Suck | 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | ||
Autonomous system | Pupils | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Heart rate | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
Respiration | 1 | 3 | 0 | 0 | 3 | 3 | 3 | 3 | 3 | 2 | ||
Rectal temperature before start of cooling (°C) | 35.8 | 36.2 | 36.8 | 35.8 | 34.0 | 35.5 | 34.0 | NA | 35.2 | 35.0 | ||
Age at start of active cooling (hours)† | 5 | 4 | 6 | 1 | 2 | 3 | 3 | 7 | 1 | 2 | ||
Age core target temperature (<34°C) achieved | 8 | 7 | 9 | Never | 3 | 6 | 4 | 8 | 3 | 4 | ||
12 | 20 | 13 | 3 | 5 | 10 | 9 | 24 | 3 | 5 | |||
C reactive protein (CRP) at the time of discontinuation of cooling (g/L) | NA | 0.5 | 66 | 2.3 | 2.4 | 23 | 5 | 56 | 0.2 | NA | ||
Maximum CRP in first 72 hours of age (g/L) | 152 | 4 | 284 | 13 | 4 | 62 | 27 | 96 | 0.4 | 330 | ||
Blood/CSF positive culture | No | No | GBS (blood) | No | No | No | No | No | No | No | ||
CSF microscopy | Negative | Not done | Negative | Not done | Not done | Not done | Not done | Negative | Not done | Negative | ||
MRI | Cortex | Normal | Normal | Normal | Normal | Normal | Normal | Normal | Abnormal | Normal | Normal | |
Basal ganglia/thalamus | Normal | Normal | Normal | Normal | Normal | Normal | Normal | Abnormal | Normal | Normal | ||
White matter | Normal | Normal | Abnormal | Abnormal | Abnormal | Abnormal | Normal | Abnormal | Normal | Normal | ||
Posterior limb of the internal capsule | Normal | Normal | Normal | Normal | Normal | Normal | Normal | Normal | Normal | Normal | ||
Lac/NAA (SE) | 0.07 (0.08) | 0.03 (0.03) | 0.07 (0.04) | 0.35 (0.06) | 0.14 (0.03) | 0.12 (0.03) | 0.18 (0.05) | 0.14 (0.04) | 0.14 (0.03) | 0.15 (0.05) | ||
Neurodevelopmental outcome at 2 years | Normal | Normal | Normal‡ | Abnormal | Normal | Normal | Normal | Abnormal‡ | Normal | Normal |
*To classify as mild encephalopathy, babies had at least one abnormality in the neurological examination, but no evidence of moderate or severe encephalopathy (which requires at least three moderate or severe abnormalities).
†Rewarming rate set at 0.25°C per hour using Criticool or Tecotherm Neo.
‡Only detailed neurological examination without Bayley-III was performed.
CSF, cerebrospinal fluid; ECM, external cardiac massage; Em LSCS, emergency lower segment caesarean section; GBS, group B Streptococcus; LOC, level of consciousness; MAS, meconium aspiration syndrome; NA, not applicable; pCO2, partial pressure of carbon dioxide; SVD, spontaneous vaginal delivery; Lac/NAA, lactate/N acetyl aspartate (>0.3 is associated with adverse neurological outcome).