Citations from the literature /International Journal of Gynecology & Obstetrics 54 (19%) 307-316 309 that may result in brain injury. It is not known whether specific abnormalities on electronic fetal monitoring are related to the risk of cerebral palsy. Methods. Among 155636 children born from 1983through 1985in four California counties, we iden- tified singleton infants with birth weights of at least 2500g who survived to 3 years of age and had moderate or severecerebral palsy. The children with cerebral palsy were compared with randomly selected control children with respect to character- istics noted in the birth records. Results. Seventy-eight of 95 children with cerebral palsy and 300 of 378 controls underwent intrapartum fetal monitoring. Characteristics found to be associated with an increased risk of cerebral palsy were muhi- ple late decelerations in the heart rate, commonly defined as slowing of the heart rate well after the onset of uterine contrac- tions (O.R. 3.9, 95% C.I. 1.7-9.3) and decreasedbeat-to-beat variability of the heart rate (O.R. 2.7, 95% C.1. 1.1-5.8); there was no association between the highest or lowest fetal heart rate recordedfor each child and the risk of cerebral palsy. Even after adjustment for other risk factors, the association of abnotmalities on fetal monitoring with an increased risk of cerebral palsy persisted (adjusted O.R. 2.7, 95% C.I. 1.4-5.4). The 21 children with cerebral palsy who had multiple late decel- erations or decmased variability in heart rate on fetal monitor- ing represented only 0.19% of singleton infants with birth weights of 2500g or more who had these fetal monitoring tind- ings, for a falsepositive rate of 99.8%. Conclusions. Specific abnormal findings on electronic monitoring of the fetal heart rate were associated with an increased risk of cerebral palsy. However, the false-positive rate was extremely high. Since cesarean section is often performed when such abnormalities am noted and is associated with risk to the mother, our findings arouse concern that, if these indications were widely used, many cesarean sections would be performed without benefit and with the potential for harm. latory and oxygen needs, hematologic changes, gastrointestinal function, time to fug enteral feeding, duration of hospitalixa- tion and age at discharge. Results. The three groups of patients were comparable in birth weight, gestational age, antenatal administration of betamethasone and other perinatal characteristics.Ibuprofen treatment significantly reduced plas- ma levels of prostagkmdins and the levels remained low for 72 h in newborns who received three dosesof the drug. The inci- dence of PDA and other variables did not differ between pa- tients who received a single dose of ibuprofen and those given saline. However, compared with the saline-treated newborns, babieswho receivedthree doses of ibuprofen had no PDA (O/12 vs. 7/11 for saline; P < 0.02), had lower daily mean airway pressures(mean f S.D., 5.2 3t 1.1 cm Hz0 vs. 8.3 * 2.8 cm Ha0 for saline; P < 0.02) and better oxygenation index (2.6 f 0.6 vs. 4.7 f 1.8 for saline; P < 0.02) at the end of the first week of life and required fewer days of ventilation (25 f 14 days vs. 44 f 26 days for saline; P < 0.03). Babies given three doses of ibuprofen tended to tolerate full oral feedings earlier (35 f 19 days vs. 56 f 34 days for saline; P = 0.09), had shorter duration of hospitalization (71.2 * 22.6 days vs. 127.3f 74.7 days for saline; P < 0.05) and were discharged to home at an earlier postconceptional age (37.8 f 2.0 weeks vs. 44.8 f 9.8 weeks for saline; P < 0.05). Ibuprofen treatment in this phase-I trial was not associated with any apparent early neurological, intestinal, renal, hepatic or hematologic complications. Conclusions. Administration of three dosesof ibuprofen within 3 h after birth in preterm neo- nates reduced the incidence of PDA without causing notable early adversedrug reactions in this phase-I trial. Early closure of the ductus arteriosus was also associated with better respira- tory outcome and earlier discharge from the hospital. Em w admMlTalioo to prepant patent duehm artdlmInpramaprnrtwnewbornInfanla Varvarigou A.; Bardin C.L.; Beharry K.; Chemtob S.; Papageorgiou A.; Aranda J.V. CAN J AM MED ASSGC 1996275/7 (539-544) Vary p&em hIrtIu a raghal study. Part I: maternal and obswrk faetnrs Hagan R.; Benninger H.; Chidings D.; Evans S.; French N. AUS BR J OBSTET GYNAECOL 1996 10313 (230-238) Objective. To test whether early postnatal (O-3 h) intrave- Objective. To ascertain the demographic, pregnancy and nous administration of ibuprofen will prevent patent ductus obstetric factors associated with the delivery of a livebom very arteriosus (PDA) in preterm neonates. Design. Prospective se- preterm infant (< 33 weeks of gestation) and to investigate any quential controlled trial with three treatment arms. Setting. differences in these factors between identifiable etiological Level 3 perinatal-neonatal intensive care nursery. Patients. groups. Design. Cohort analytical study. Setting. King Edward Thirty-four premature newborn infants born from February to Memorial Hospital for Women (KEMH), Western Australia. August 1993 with a mean birth weight of 913 g (range 565-1460 Main variables examined. Maternal demographic and obstetric g) and gestational age of 26.9 weeks (range 22.4-31.0). Inter- history, primary complication associated with delivery, vention. Infants were consecutively assignedwithin 3 h of age obstetric managementand mode of delivery. Results. Sii hun- to treatment with either one dose of ibuprofen lysine (10 mg/kg dred eight women were delivered of 693 livebom very preterm intravenously) followed by 5 mg/kg per dose intravenously at infants in Western Australia between 1.190 and 31.12.91, 24 and 48 h of age (n = 12), one dose of ibuprofen lysine (10 representing 1.22% of all women who were delivered of a mg/kg intravenously; n = 1I) or saline (n = 11). Outcome vari- livebom infant in those years. Singleton pregnancy occurred in ables. Primary outcome variable was the presence of ductus 517(85%),and 541(89%) were delivered in KEMH. Mean ma- arteriosus by echocardiography and clinical assessments at 3,7 ternal age was 28 years with an excess of mothers less than 20 and 21 days of life. Secondary outcome variables included years of age and older than 34 years compared with the presence of intraventricular hemorrhage, renal function, venti- statewide perinatal data. Preeclampsia (n = 128, 21.1%),