Effects of electronic fetal-heart-rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants

In a multicenter, randomized clinical trial, we assessed the early neurologic development of 93 children born prematurely whose heart rates were monitored electronically during delivery and compared it with that of 96 children born prematurely whose heart rates were periodically monitored by auscultation. All the children were singletons with cephalic presentation, and all weighed ≤ 1750 g at birth. The mental and psychomotor indexes of the Bayley Scales of Infant Development (standardized mean score ±SD, 100±16) and a formal neurologic examination were administered at three follow-up visits (at 4, 8, and 18 months of age, corrected for gestational age). At 18 months, the mean mental-development scores in the groups receiving electronic fetal monitoring and periodic auscultation were 100.5±2.4 and 104.9±1.8, respectively (P>0.1). The mean psychomotor-development scores in the two groups at 18 months were 94.0±2.4 and 98.3±1.8, respectively (P>0.1). The incidence of cerebral palsy was higher in the electronically monitored group —20 percent as compared with 8 percent in the group that was monitored by auscultation (P<0.03). In the electronicfetal-monitoring group (but not in the periodic-auscultation group), the risk of cerebral palsy increased with the duration of abnormal fetal-heart-rate patterns, as assessed by retrospective review (χ² trend = 12.71, P<0.001). The median time to delivery after the diagnosis of abnormal fetal-heart-rate patterns was 104 minutes with electronic fetal monitoring, as compared with 60 minutes with periodic auscultation. We conclude that as compared with a structured program of periodic auscultation, electronic fetal monitoring does not result in improved neurologic development in children born prematurely. (N Engl J Med 1990; 322: 588–93.).