Both elevated umbilical artery (UA) lactate and maternal fever have been independently associated with poor neonatal outcomes, including acidosis, hypoxic-ischemic encephalopathy, cerebral palsy, etc. We sought to determine whether maternal intrapartum fever had an impact on neonatal metabolic status, as determined by UA pH, lactate and base-excess. STUDY DESIGN: In this prospective cohort study, UA cord blood samples were collected from vaginal and cesarean singleton deliveries that occurred between June and August 2019 at a tertiary care center. UA pH, lactate and base excess were then assessed using a GEM 4000 blood gas analyzer. Presence of maternal intrapartum fever (temperature > 31.5 C or 100.5 F during labor) were determined from medical records. RESULTS: 205 samples were included in the study. There was no statistically significant difference in UA pH between births complicated by maternal fever (n¼9, mean pH 7.20) and those not complicated by fever (n¼196, pH 7.23, p¼0.328). However, the mean UA lactate in the maternal fever group was significantly higher than that of the non-fever group (6.04 mmol/L vs. 4.47 mmol/L, respectively, p¼0.002). Mean base excess was also significantly lower in the maternal fever group (-7.87 mEq/L vs.-5.45 mEq/L in the non-fever group, p¼0.0142). CONCLUSION: Though UA pH did not differ between the groups, neonates born to mothers with intrapartum fevers were found to have significantly higher UA lactate and lower base excess than those born to mothers who remained afebrile at delivery. This suggests the presence of fetal metabolic challenge that would not have been evident when only using UA pH as an assessment of neonatal metabolic status. Further research is needed to determine the clinical significance of these findings with respect to neonatal outcomes.

Neonatal acidosis, generally defined as an umbilical artery (UA) pH of less than 7.00, 1 has been linked to significant neonatal morbidity, including hypoxic ischemic encephalopathy, intraventricular hemorrhage, cerebral palsy, seizures, and increased rates of neonatal intensive care unit (NICU) admissions and neonatal mortality. [2][3][4][5][6] These associations are thought to be mediated by peripartum hypoxic injury to the fetus, which results in tissue ischemia and increased anaerobic metabolism that is then reflected in a low UA pH at birth.Along with other measures of neonatal well-being, such as APGAR scores, UA pH has been used as a quality indicator among labor wards and as part of the diagnostic and prognostic pathways for neonatal hypoxic-ischemic injury. [1][2][3][4]7,8 However, assessment of pH poses significant limitations if used as a proxy measure for metabolic status. pH is exponentially altered by small changes in respiratory and metabolic function. 9 As such,

OBJECTIVE: To determine if increased body mass index (BMI) impacts incision to delivery interval, in the setting of category II and III fetal heart-rate tracing, necessitating emergent cesarean delivery. STUDY DESIGN: A retrospective cohort study of all emergent cesarean deliveries occurring at one institution from 2012-2018. Three comparison groups were divided by BMI /¼35 kg/cm2 (n¼51). The primary outcome was time from operating room and skin incision to infant delivery. Secondary outcomes were a measure of neonatal morbidity: 5-minute Apgar score less than 7, umbilical cord arterial pH, and NICU admission. RESULTS: There was a statistically significant difference in the length of time from arrival in the operating room to delivery and from incision to delivery for patients with higher BMI (p¼0.037 and 0.025). There were also higher rates of fetal acidosis in fetuses born to moms with a higher BMI (p¼0.047). these findings were consistent when controlling for number of prior laparotomies and when excluding patients who received general anesthesia. CONCLUSION: These findings support prior literature that describe a longer incision to delivery interval in patients undergoing cesarean delivery, as well as worse neonatal outcomes in patients with a larger BMI. Our study is unique in the sense that it describes this challenge in the context of urgent cesarean deliveries. We advise the Obstetrician to consider these findings when patients with large BMI have fetal heart rate tracings that do not respond to initial resuscitative efforts.

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INTRODUCTION: Umbilical artery (UA) lactate and pH aid the diagnosis of neonatal acidosis. This study examines the relationship between point-of-care (POC) measurement of combined umbilical arterial and venous (CUAV) lactate and UA lactate and pH to determine whether this POC assessment could serve as an alternative screening modality for neonatal acidosis. METHODS: In this prospective cohort study, UA and CUAV cord blood samples were collected from vaginal and cesarean deliveries occurring between June and August 2019 at a tertiary care center. UA samples were analyzed for pH and lactate using a standard laboratory blood gas analyzer (GEM 4000). CUAV lactate was analyzed at the POC (StatStrip Xpress Lactate Meter, off-label indication, IRB-approved) as well as on the blood gas analyzer. Short-term neonatal outcomes, including 1- and 5- minute APGAR scores and NICU admission rates were also assessed. RESULTS: N=190. There was a statistically significant correlation between POC CUAV lactate concentrations and UA lactate concentrations (R2=0.806 P=2.2 x 10-16). Additionally, there was a statistically significant correlation between the CUAV lactate concentrations obtained using the POC device and the GEM analyzer (R2=0.934 P=2.2 x 10-16). R2=0.95 for technical replicates of POC CUAV lactate concentration measurements. There was no statistically significant association between POC CUAV lactate and UA pH (R2=0.223 P=2.4 x 10-6). CONCLUSION: POC testing of CUAV lactate is reliable and closely correlated with UA lactate concentrations, making POCT CUAV lactate a feasible screening test for neonatal acidosis. More data is needed to establish the sensitivity and specificity of this test and its association with clinical neonatal outcomes.