[Psychomotor development of children with signs of intrapartum hypoxia and monitored by intrapartum fetal pulse oxymetry].

OBJECTIVE: The following questions were investigated: 1) the psychomotor development in newborns with pathological cardiotocographic recording (CTG), having been born spontaneously due to a normal oxygen saturation monitored by intrapartum pulse oxymetry (IFPO)(group I), 2) possible difference in development of children in group I in comparison with those with pathological CTG without IFPO monitoring delivered by cesarean section (group II), 3) possible differences in children in these two groups with signs of intrapartum hypoxia (groups I and II, respectively) from children delivered spontaneously during physiological delivery without signs of hypoxia (group III).

DESIGN: A prospective clinical study

SETTING: Institute for the Care of Mother and Child

METHODS: There have been 88 children born in the years 2000-2001 from singleton pregnancies in gestational ages > 36 weeks. Three groups of children were established: 1) in the group I (IFPO, n=32) there were children born spontaneously having pathological CTG detected by cardiotocograph HP50A and simultaneously monitored by intrapartum fetal pulse oxymeter NELLCOR Puritan Benett A400 with the NELLCOR FE 14 sensor with normal values of oxygen saturation. The children of group II (CTG-SC, n=25) were born by cesarean section due to acute intrapartum fetal hypoxia (IH) indicated by CTG recording without IFPO. The group III (physiological, n=31) was formed by children from physiological deliveries without signs of IH. All children underwent psychological examination at the average age of 21.8 months by the Bayley Scales of Infant Development (BSID-II). The statistical analysis of data was performed according to the variables using t-test or chi-square test, respectively.

RESULTS: Group I (IFPO) did not differ significantly from group II (CTG-SC) in any area of psychological evaluation. The prevention of cesarean section due to IFPO method in the group I therefore prevented a significant increase of psychological morbidity in children of this early age. In spite of that the children of the group I (IFPO) reached the lowest evaluation and differed significantly from the most favorably evaluated group III (physiological) in motor development, behavior, and in a total number of deviations. Group II (CTG-SC) was evaluated significantly worse in comparison with group III (physiological) only in behavior items. On the other hand the occurrence of children of above-average mental development in the groups I and II were the same as in group III. The results indicate complex character of the problem.

CONCLUSION: The prevention of CS due to IFPO prevented a development of psychological morbidity in children. The increased occurrence of deviations in psychomotor development of children with signs of acute IH (groups I and II) in comparison with children of group III (physiological) will be analyzed in detail in relation to further data.