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Am J Perinatol
DOI: 10.1055/a-2811-5092
Original Article

Whole-Body Hypothermia for Hypoxic–Ischemic Encephalopathy and Route of Delivery

Authors

  • Sneha Paranandi

    1   Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware, United States

  • Fabrizio Zullo 

    2   Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy

  • Kelley Z. Kovatis

    3   Department of Neonatology, Christiana Care Health System, Newark, Delaware, United States

  • Anthony C. Sciscione

    4   Delaware Center for Maternal-Fetal Medicine of ChristianaCare, Newark, Delaware, United States

  • Matthew K. Hoffman

    1   Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware, United States

  • Suneet P. Chauhan

    4   Delaware Center for Maternal-Fetal Medicine of ChristianaCare, Newark, Delaware, United States
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Abstract

Objective

This study aimed to compare the antenatal and intrapartum characteristics of newborns at ≥36.0 weeks, who underwent whole-body hypothermia for hypoxic–ischemic encephalopathy (HIE) and had either cesarean or vaginal deliveries.

Study Design

Retrospectively, we identified all non-anomalous singletons at ≥36.0 weeks who had HIE and underwent whole-body hypothermia at a community teaching hospital. Differences in baseline characteristics and intrapartum factors were compared among the cesarean versus vaginal deliveries using chi-square tests. Multivariable Poisson regression models were used to estimate the association between delivery route and various outcomes with adjustment for potential confounders.

Results

Of the 32,765 deliveries during the study period, 132 (0.4%) met the inclusion criteria, and among them, 79 (59.8%) had cesarean deliveries, and the remaining 53 (40.1%) had vaginal births. The prenatal care providers (i.e., private, community hospital faculty, or others) differed significantly between the two groups (p = 0.013). Within 60 minutes of hospitalization, the characteristics of fetal heart rate tracing (FHRT) and its category (I, II, or III) did not differ between the groups. Sentinel events occurred among 25.3% of those who had cesarean and 30.2% of those who delivered vaginally (p = 0.556). FHRT 60 minutes prior to delivery did not differ with regard to the presence of decelerations (p = 0.409), and variability (p = 0.199), but whether it was category I, II, or III (p = 0.030) did vary significantly. The likelihood of neonatal seizure (adjusted incidence rate ratio = 1.03; 95% confidence interval: 0.41–2.58) and mortality (1.10; 0.03–45.5) were similar between the groups.

Conclusion

Occurring in approximately 4 per 1,000 deliveries at a community teaching hospital, the majority of singletons who had whole-body cooling had cesarean delivery. While the category of FHRT did not differ significantly within 60 minutes of admission, it did differ 60 minutes before birth.

Key Points

  • Whole-body hypothermia (WBH) occured in 4/1,000 births.

  • About 60% of newborns with WBH had cesarean delivery.

  • Neither braddycardia nor tachycardia was noted with 132 cases of WBH.

  • Categories of fetal heart rate tracing differed significantly among those delivered vaginal versus cesarean.

Keywords

Apgar score - fetal heart rate tracing - hypoxic–ischemic encephalopathy - intrauterine resuscitation - neonatal seizure - neonatal mortality - sentinel events - umbilical artery pH - umbilical artery base excess

Note

This study was presented as a poster at the Society of Maternal-Fetal Medicine Annual Pregnancy Meeting in Denver, CO, from January 30, 2025, to February 1, 2025.


Supplementary Material



Publication History

Received: 11 November 2025

Accepted: 10 February 2026

Accepted Manuscript online:
16 February 2026

Article published online:
25 February 2026

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