Fetus-Placenta-NewbornOutcomes among term infants when two-hour postnatal pH is compared with pH at delivery☆
Section snippets
Material and methods
Umbilical artery blood is obtained for acid-base analysis from all live births at our hospital. From January 1, 1988, to August 31, 1998, there were 153,462 live births at Parkland Memorial Hospital, Dallas, and 5465 (3.6%) of these infants also had radial artery or umbilical artery blood obtained for blood gas analysis within 2 hours after delivery. A total of 1691 of these infants were delivered at term (≥37 weeks’ gestation) and had development of respiratory symptoms during the immediate
Results
The 1691 term infants with paired delivery and neonatal blood gas analyses included 36 twins (2%) and 77 singleton breech presentations (5%). Fifty-seven percent of the infants (n = 959) were male. Fifty-two percent of the mothers were Hispanic, 32% were black, and 14% were white. Forty-seven percent of the mothers were nulliparous, and the mean (±SD) maternal age was 24 ± 6 years.
As shown in Fig 1, the infants with acidemia were divided into groups A through C according to the direction of pH
Comment
This investigation was designed to analyze the prognoses of neonates with acidemia present at birth or developing within 2 hours after birth. Those infants who were born with acidemia and continued to have acidemia had the worst prognosis for morbidity and mortality. For example, the odds ratio for seizures among these infants was 13 relative to the reference group of infants who did not have acidemia either at birth or during the immediate neonatal period. In contrast, the odds ratio for
References (10)
- et al.
Asphyxial complications in the term newborn with severe umbilical acidemia
Am J Obstet Gynecol
(1992) - et al.
Do Apgar scores indicate asphyxia?
Lancet
(1982) - et al.
Pathologic fetal acidemia
Obstet Gynecol
(1991) - et al.
Acid-base homeostasis of the newborn infant during the first 24 hours of life
J Pediatr
(1958) - et al.
Fetal and neonatal acid-base balance in normal and high-risk pregnancies
Obstet Gynecol
(1973)
Cited by (30)
Risk factors for and consequences of difficult fetal extraction in emergency caesarean section. A retrospective registry-based cohort study
2023, European Journal of Obstetrics and Gynecology and Reproductive BiologyAssociation of umbilical cord blood gas values with mortality and severe neurologic injury in preterm neonates <29 weeks’ gestation: a national cohort study
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :However, none of the 4 studies specifically included preterm neonates of <29 weeks’ gestation. In preterm neonates, the association between deranged umbilical cord blood gas values and neurologic morbidities is inconsistent with some studies reporting higher odds of intraventricular hemorrhage (IVH),7 periventricular leukomalacia (PVL),8 and seizures9 with varying pH thresholds and others reporting no associations.10–12 In term neonates, lower pH, higher partial pressure of arterial CO2 (PaCO2), and higher mean base excess (BE) in the umbilical cord arteries were associated with hypoxic-ischemic encephalopathy, cardiopulmonary resuscitation, seizure, intubation, and intrauterine growth restriction.13
Intrapartum asphyxia: Risk factors and short-term consequences
2016, Journal de Gynecologie Obstetrique et Biologie de la ReproductionPerinatal biology: The paediatrician's view?
2015, Revue Francophone des LaboratoiresRelationship between oxygen saturation and umbilical cord pH immediately after birth
2012, Pediatrics and Neonatology
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Reprint requests: Brian M. Casey, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9032.