How Well Can Experienced Clinicians Identify Pending Neonatal Encephalopathy Using EFM?
BACKGROUND AND PURPOSE:
The clinical utility of EFM has been challenged, but there is evidence that it may reduce neonatal seizures
Farquhar et al. (JAMA Netw Open., 2020) explored whether experienced clinicians could detect and develop action plans for abnormal FH tracings that were recorded during the next to last hour before birth of infants who were diagnosed with moderate to severe neonatal encephalopathy (NE)
Case-control study (New Zealand)
Practicing, experienced obstetricians and midwives
Completed a fetal surveillance education program within 2 years
Neonatal encephalopathy (NE)
Defined as “disordered neonatal brain function within the first week of life in term infants”
Participants were masked to the perinatal outcome | Provided with clinical details and 1 hour of FH tracing from 2 hours before birth
Case group: Tracings from neonates with NE and evidence of birth hypoxia and without an acute perinatal event
Control group: Tracings from neonates without NE or birth hypoxia
Clinicians recommended a plan based on their assessment
A year later, clinician assessors were asked to relook at the tracings
80% power at a significance level of .05 to detect a difference in rates of immediate response for abnormal tracing | Assumption based on difference in rates (controls vs cases): 1% and 15%, 5% and 25%, and 10% and 35%
Sensitivity for detection of hypoxia: Proportion of cases where tracing was read as abnormal
Sensitivity for appropriate management of hypoxia: Proportion of cases where assessors developed an immediate plan (e.g. immediate delivery by cesarean or instrumental delivery) dependent on clinical findings
Specificity: Proportion of controls where assessors rated a tracing as normal and made no plan for immediate action
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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