Comparisons between umbilical cord biomarkers for newborn hypoxic–ischemic encephalopathy

Daboval, Thierry; Ouellet, Paul; Charles, F. Lynch; Booth, Ronald A.; MacLean, Gillian; Roeper, Rhiana; Racinet, C

doi:10.1080/14767058.2019.1688292

Cited by 8 publications

(7 citation statements)

References 33 publications

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“…Paradoxically, although fetal metabolic acidemia (a direct consequence of hypoxia [ 32 ]) had a three-fold increase in incidence in the prAEDF group compared with the trAEDF group, the difference was not statistically significant, probably due to the limited number of cases.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome

Tica

Doriana

et al. 2021

Annals of Medicine

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Background Absent end-diastolic flow (AEDF) in the umbilical artery (UA) worsens the already poor prognosis of growth-restricted fetuses (GRFs) in pregnancies complicated by early-onset preeclampsia with severe features (ESP). Method We assessed the correlation between the effect of maternal dexamethasone (Dex) on AEDF in the UA and perinatal outcomes, in 59 GRFs from EPS-complicated pregnancies. The maternal outcome was also evaluated. Results The mean maternal age at inclusion was 22.4 ± 5.9 years. Dex transiently restored EDF in the UA in 38 (64.4%) cases (trAEDF group), but in 21 (35.6%) patients, the flow was persistently absent (prAEDF group). The effect lasted up to the 4th day. The gestational age at diagnosis, number of days from admission until delivery, and fetal weight were significantly lower in the prAEDF group than in the trAEDF group ( p < .05). The same group had a significantly increased rate of fetal proximal deterioration, low APGAR scores, neonatal hypoxia, assisted ventilation, mild intraventricular haemorrhage (I/II), and respiratory distress syndrome, as well as maternal deterioration, especially in cases of resistant hypertension ( p < .05). Although the rates of fetal acidemia and perinatal mortality in the prAEDF group were respectively three times and two times higher, the differences were not significant ( p > .05). Conclusions The Dex no-effect on UA Doppler in GRFs with AEDF in the UA, in EPS-complicated pregnancies, can be a useful marker for a higher risk of proximal fetal deterioration, poor state at delivery, neonatal hypoxic complications, and worsening maternal condition, but not for perinatal mortality. The findings also highlight the alarmingly younger age of patients with EPS. Finally, all these pregnancies should be monitored in a complex multidisciplinary manner in tertiary referral units. Key message The effect of dexamethasone on absent end-diastolic flow in the umbilical artery in growth-restricted fetuses from pregnancies complicated by early-onset preeclampsia with severe features can be a useful prognostic factor for perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome

Tica

Doriana

et al. 2021

Annals of Medicine

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“…We defined our primary outcome—detected and undetected HIE or death—based on three umbilical artery blood markers: umbilical artery pH <7.00; base deficit ≥16 mmol/L as described in published guidelines for hypothermia treatment 5,6 ; and neonatal eucapnic pH ≤7.14, best cut‐off value calculated by the Youden index 18,22 …”

Section: Methodsmentioning

confidence: 99%

“…We defined our primary outcome-detected and undetected HIE or death-based on three umbilical artery blood markers: umbilical artery pH <7.00; base deficit ≥16 mmol/L as described in published guidelines for hypothermia treatment 5,6 ; and neonatal eucapnic pH ≤7.14, best cut-off value calculated by the Youden index. 18,22 We used the umbilical artery blood sample results of all normal newborn infants born during the study period to create a scatterplot of umbilical artery pCO 2 against pH . On the graph, we highlighted newborn infants with HIE or death.…”

Section: Primary Outcomementioning

confidence: 99%

“…It demonstrated that for newborn infants with borderline umbilical artery pH between 7.00 and 7.15, neonatal eucapnic pH had the largest area under the curve (AUC = 0.853) and best positive likelihood ratios (LR +2.40 to 2.91) for sensitivity ≥80% compared to umbilical artery pH (AUC = 0.614; LR +1.20 to 1.28) and base deficit (AUC = 0.778; LR +1.00 to 2.85). 18 However, ROC curves maybe difficult to understand for clinicians. These curves do not describe how pCO 2 may influence the risks of birth depression and HIE.…”

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confidence: 99%

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Umbilical artery carbon dioxide decreases the risk for hypoxic‐ischaemic encephalopathy

2020

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Umbilical artery blood analysis assesses foetal well-being at birth or shortly after birth. 1 In utero, an asphyxiated foetus develops respiratory acidosis that may last approximately 10 to 20 minutes and progresses to mixed respiratory and metabolic acidosis with evolving asphyxia. After birth, respiratory component dissipates with regular breathing or ventilation but metabolic acidosis indicates a lasting hypoxic event. 2 Metabolic acidosis is accepted as an essential marker for identifying peripartum hypoxia that may lead to hypoxic-ischaemic encephalopathy (HIE) and later to cerebral palsy. 1,3,4 Professional societies define foetal acidaemia as pH <7.00 or base deficit ≥12 mmol/L or both as the threshold associated with an increased risk for neurological complications. 1 However, a base deficit threshold ≥16 mmol/L is used by other professional societies as screening criteria for hypothermia treatment. 5,6 Because base deficit is traditionally accepted for calculating the metabolic component of the acidosis corrected for pCO 2 , clinicians tend to disregard pCO 2 when interpreting cord gas values.

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“…[14][15][16][17][18] It is therefore useful to look for an early marker, simple to calculate, accurate and specific for NMA: the concept of eucapnic pH at birth (pH euc-n) was explored and estimated in 2007 by Blickstein and Green 19 and then revised in 2016 by Racinet et al, 6 which has already been tested favorably in two retrospective studies. 20,21 However, we note that, in practice, pH euc-n is still under-used because it requires calculations (Figure S1). The decision threshold for pH euc-n, tentatively provided by our previous retrospective studies, is estimated at ≥7.14: 21 below this value, it is considered possible to confirm the presence of potentially pathogenic NMA.…”

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confidence: 99%

Eucapnic pH coupled with arterial cord pH improves hypoxic–ischemic encephalopathy prediction

Gauci,

Racinet,

Ouellet

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo consider the classical use of “pH < 7.0 and/or a base deficiency ≥12 mmol/L” as markers of the risk of neonatal hypoxic–ischemic encephalopathy (HIE), recalling various criticisms of the use of these markers in favor of that of neonatal eucapnic pH, which appears to be a better marker of this risk.MethodsFifty‐five cases of acidemia with pH < 7.00 were collected from a cohort from the Nice University Hospital with eight cases of HIE. We compared the receiver operating characteristics curves established from the positive likelihood ratio (+LR) for each case of: umbilical cord artery pH (pHa), neonatal eucapnic pH (pH euc‐n) in isolation (not matched to pHa), and matched pHa to its own pH euc‐n.ResultsThe areas under the curve (AUC) are identical for pHa and pH euc‐n, but AUC for the matched pair pHa–pH euc‐n appears superior but non‐significant because of the small number in our cohort. However, using the bootstrap method, the partial AUC for a sensitivity greater than 75% indicates the significant superiority (P < 0.01) of the matched pair pHa–pH euc‐n approach.ConclusionThe originality of this study lies in the use of two methodologic approaches: (1) standardized partial analysis of the AUCs of the pHa curve and that of pHa matched to its own pH euc‐n, and (2) bootstrap statistical technique, that allowed us to conclude (P < 0.01) that the combined use of pH measured at the cord coupled with its eucapnic correction is better for diagnosing metabolic acidosis and best predicting the risk of HIE.

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Comparisons between umbilical cord biomarkers for newborn hypoxic–ischemic encephalopathy

Cited by 8 publications

References 33 publications

Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome

Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome

Umbilical artery carbon dioxide decreases the risk for hypoxic‐ischaemic encephalopathy

Eucapnic pH coupled with arterial cord pH improves hypoxic–ischemic encephalopathy prediction

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