Optimal care during labor can prevent brain injury in newborns
Keywords:Severe brain injury in a newborn may occur unnoticed, but it is not always inevitable. A recent study conducted by HUS and the University of Helsinki shows that in half of the cases where the cardiotocogram (CTG) was normal at admission, the brain injury could have been prevented. It is estimated that about one-fifth of all brain injury cases could have benefited from preventive measures.
Mikko Tarvonen's research brings new hope to maternity hospitals, even though the incidence of hypoxic-ischemic encephalopathy in newborns has already been considered very low in developed countries.
Brain injury due to lack of oxygen, that is hypoxic-ischemic encephalopathy (HIE), is one of the most common causes of newborn deaths in the world. The general view for a long time has been that most brain injuries in newborns occur already before childbirth, and that they cannot be prevented at a hospital.
“Our research challenges that view, since in half of the cases, where the cardiotocogram was normal at admission, the brain injury could have been prevented,” says Midwife and Researcher Mikko Tarvonen from HUS.
The study conducted by the University of Helsinki and HUS has been published in the esteemed American Journal of Obstetrics and Gynecology.
The 20-year research data included over 317,000 full-term childbirths in HUS maternity hospitals in 2005–2024. Hypoxic-ischemic encephalopathy was diagnosed in 314 children. Cases where the brain injury was proven to be caused by a genetic or congenital illness were excluded from the research data.
Abnormal CTG may predict potential preventable brain injury
The innovative study design examined the manner of origin and time of occurrence of brain injuries by analyzing CTGs and looking for signs of hypoxia in the umbilical cord and the newborn's blood. In addition, the placental tissue was examined with a microscope.
The results were clear: if the CTG was abnormal at admission, the risk that a brain injury had already occurred was 11-fold. The most severe cases, including deaths, were most clearly related to abnormal CTGs in early labor.
Some brain injuries occur in quick, unexpected situations, such as preterm placental abruption, and the research separated these cases from others. In the remaining group, even 50% of the cases were assessed to have been preventable. When cases where the admission CTG was abnormal were included, it was estimated that 22 percent of cases were preventable.
Monitoring the progress of labor and quick reactions are essential
Nearly half of the brain injuries caused by lack of oxygen occurred in low-risk pregnancies. This means that performing a risk analysis alone during pregnancy is not enough: the progress of labor and reacting to signs of distress is essential.
“The quality of care during childbirth is the key. Professional staff, knowledge on how to interpret the CTG, and correctly timed reactions to signs of distress in the fetus may save a life or prevent brain injury,” explains Tarvonen.
Neonatal hypoxic-ischemic encephalopathy has long been thought to be an injury whose occurrence in developed countries is already as low as it can possibly be. The research by Tarvonen and his colleagues brings new hope to maternity hospitals also in developed countries.
“With optimal care during childbirth, even more hypoxic-ischemic encephalopathies can be prevented than previously thought and many lives saved. Our results can be adopted in all childbirths worldwide, regardless of the place of delivery.”
Neonatal hypoxic-ischemic encephalopathy (HIE)
- If the fetus experiences a lack of oxygen in the uterus, they may develop neurological damage called hypoxic-ischemic encephalopathy.
- In survivors, HIE leads to several kinds of complications in neurodevelopment, which vary from minor damages to extreme injuries that hinder functional capacity in childhood and later life.
- HIE causes significant suffering to children and their loved ones. Also, the financial burden caused by HIE to society is extremely high.
- HIE affects 1 to 4 per 1000 live term births in developed countries. In the present study population, the incidence of HIE was 0.99 per 1000 liveborn.
- This new research evidence shows that HIE can be prevented with optimal care during childbirth in many more cases than previously thought.