Neonatal complications in newborns with an umbilical artery pH <7.00,☆☆,

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Abstract

OBJECTIVE: Our purpose was to determine the significance of an umbilical artery pH <7.00 in relation to neonatal morbidity and mortality. STUDY DESIGN: Between 1986 and 1993 acid-base assessment of the umbilical artery was performed routinely in 10,699 deliveries. In a retrospective cohort study 84 nonanomalous neonates with an umbilical artery pH <7.00 were individually matched with 84 neonates with an umbilical artery pH >7.24. Matched variables included year of delivery, gender, parity, maternal age, delivery mode, fetal presentation, gestational age, and birth weight. Differences in morbidity between the two groups during the neonatal period (until 28 days after delivery) were investigated. RESULTS: Neonates with an umbilical artery pH <7.00 versus >7.24 showed significant differences in the following: neonatal condition directly post partum; neurologic, respiratory, cardiovascular, and gastrointestinal complications; and neonatal intensive care unit admissions. No significance was found in renal dysfunction and mortality rate. The proportion of premature infants (<37 weeks) was 17% in both groups. In the acidotic group a 1-minute Apgar score ≤3 and a 5-minute Apgar score <7 was predictive for neonatal complications. CONCLUSIONS: Severe intrapartum asphyxia, quantified by an umbilical artery pH <7.00, poses a threat to the neonate's health. (Am J Obstet Gynecol 1996;175:1152-7.)

Section snippets

METHODS

Between January 1986 and December 1993, 14,025 infants were born alive at the University Hospital of Nijmegen. Umbilical cord blood samples were routinely obtained during this period. Immediately after delivery the umbilical cord was double clamped; arterial and venous blood samples were taken by the obstetric floor personnel with a preheparinized syringe. These samples were analyzed within 20 minutes after delivery on a blood gas analyzer (Ciba-Corning 288, Medfield, Mass.). Results of these

RESULTS

The demographic and intrapartum characteristics of the 84 pregnancies (70 term and 14 preterm neonates) in the acidotic and control groups are summarized in Table I and compared with the general obstetric population of the University Hospital of Nijmegen over the same time interval (1986 to 1993) and with the neonates in the acidotic group that could not be matched. In the study group the percentage of nulliparous patients, breech presentations, vaginal operative deliveries, multiple

COMMENT

In numerous studies the role of labor and delivery as a cause of neonatal morbidity has been investigated. The relationship between umbilical artery pH as a measure of intrapartum asphyxia and newborn morbidity remains, however, unclear. This may be because there is no consensus on the definition of acidosis. Umbilical artery pH values defined as acidosis range from 7.206, 10 to 7.00.3, 4, 5 Goldaber et al.4 and Gilstrap et al.3 proposed a pH of 7.00 as a reasonable definition of fetal

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    Hypoxic ischemia is one of the major factors involved in the pathogenesis of asphyxia (Belai et al., 1998; Vannucci and Perlman, 1997) and is thought to contribute not only to mortality and morbidity in neonates, but also to poor neurodevelopmental outcomes. Other factors that are encountered regularly in perinatal asphyxia, such as hypercapnia and acidosis, also play a key role in its negative neurological consequences observed during childhood (Roemer and Beyer, 2008; Stevens et al., 1999; van den Berg et al., 1996). Remarkably, a linear relationship has been reported between the pH in the umbilical cord and learning ability (Stevens et al., 1999).

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From the Departments of Obstetrics and Gynecologyaand Pediatrics,bUniversity Hospital Nijmegen.

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Reprint requests: Paul P. van den Berg, MD, PhD, Department of Obstetrics and Gynaecology, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

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