Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction

Gilstrap, Larry C.; Leveno, Kenneth J.; Burris, Jody; Williams, Monique; Little, Bertis B.

doi:10.1016/0002-9378(89)90410-9

Cited by 232 publications

(117 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are sufficient data from large studies to provide sensible guidance to universal cord blood collection. It is currently believed that newborns are at risk from complications directly resulting from intrapartum asphyxia only if the umbilical arterial pH is <7.00 in combination with low Apgar scores 2,5 . Isolated cord arterial blood acidaemia does not appear to have any clinical significance in the vigorous newborn 1,2 .…”

Section: Discussionmentioning

confidence: 99%

Cord blood sampling at delivery: do we need to always collect from both vessels?

Tong

2002

BJOG: An International Journal of Obstetrics and Gynaecology

View full text Add to dashboard Cite

The literature suggests that up to 19% of umbilical cord blood samples are invalid. Accordingly, it has been proposed that blood should be universally collected from both vessels. We prospectively collected paired arterial and venous blood to examine whether our centre, where staff were experienced in single vessel collection, was more accurate. Of 289 paired samples, 53 (18.3%) were considered invalid. Despite this significant error rate, we propose that routinely, only arterial sampling is needed and that an additional venous sample need only be taken to validate samples in cases of pH < 7.15, a difficult delivery or a non-vigorous baby.

show abstract

Section: Discussionmentioning

confidence: 99%

Cord blood sampling at delivery: do we need to always collect from both vessels?

Tong

2002

BJOG: An International Journal of Obstetrics and Gynaecology

View full text Add to dashboard Cite

show abstract

“…Electronic fetal monitoring of heart rate patterns in labor or the traditional signs of fetal distress have not proved to predict long-term neurological outcome 4 . The same has been observed by meconial fluid analysis, Apgar scores, excess pH and base measurements, and other specific markers of systemic lesions, many of which are still only available in experimental or clinical research centers [5][6][7][8][9][10] . There are also limitations with later indicators of brain injury, such as electroencephalography (EEG), polysomnography, evoked potential, blood flow studies, and neuroimaging, because not all these techniques are widely available, and it is not clear how specific they are for PA or to what extent they reflect primary as opposed to downstream pathology 11 .…”

Section: Introductionmentioning

confidence: 65%

Compensatory rebound of body movements during sleep, after asphyxia in neonatal rats

Suarez

Hoshino

2008

Acta Cir. Bras.

View full text Add to dashboard Cite

Purpose:The usefulness of body movements that occur during sleep when assessing perinatal asphyxia and predicting its longterm consequences is contradictory. This study investigated whether neonatal rats manifest these movements in compensatory rebound after asphyxia, and if these alterations play an important role in its pathogenesis. Methods: Eight neonatal rats (aged 6-48h) were implanted with small EMG and EKG electrodes and sleep movements were recorded over a 30-minute control period. Recordings were continued during asphyxia caused by the enclosure of the animal in a polyvinyl sheet for 60 minutes, followed by a 30-minute recovery period. Results: Heart rate was lowered to bradycardic level during asphyxia causing behavioral agitation and increased waking time during the initial phase (30 minutes). Sleep-related movements were also significantly reduced from 12.5 ± 0.5 (median ± SE/2min) to 9.0 ± 0.44 in the final half of the period (Anova, p<0.05). Movement frequency increased in the recovery period to 15.0 ± 0.49 (Anova, p<0.05). Conclusion: These data show that newborn rats present compensatory rebound of body movements during sleep which may help in the diagnosis of asphyxia and other problems related to sleep parameters. Key words: Sleep. Infant, Newborn. Asphyxia. Motor Activity. Rats. RESUMO Objetivo:A utilidade dos movimentos corporais (MC) que ocorrem durante o sono para diagnosticar e predizer as conseqüências, em longo prazo, da asfixia perinatal é contraditório. Este estudo investigou se ratos recém-nascidos (RN) manifestam MC em resposta compensatória à asfixia, e se estas alterações podem ter alguma importância na sua patogênese. Métodos: Oito ratos RN (6-48h de vida) foram submetidos à implantação de pequenos eletrodos para registros da eletromiografia e eletrocardiografia. Os MC e a freqüência cardíaca (FC) foram registrados durante períodos de 30 min: fase controle (F 1 ), fases de asfixia (F 2 ; F 3 ) e fase de recuperação pós-asfixia (F 4 ). A asfixia foi promovida pelo envolvimento completo do animal com uma lâmina de polivinil. Resultados: A FC diminuiu progressivamente durante F 2 e F 3 até a bradicardia. Em F 2 houve grande agitação dos animais e aumento dos períodos de vigília. Em F 3 houve redução significante dos MC de 12,5 ± 0,5 (Md ± SE/2min) para 9,0 ± 0,44 (P<0,05). A freqüência dos MC aumentou em F 4 para 15,0 ± 0,49. Conclusão: Estes dados mostram que ratos RN com asfixia apresentam MC compensatórios durante o sono que podem ajudar no diagnóstico desta afecção e de outros problemas relacionados aos parâmetros do sono. Descritores: Sono. Recém-Nascido. Asfixia. Atividade Motora. Ratos.

show abstract

“…Tem sido mostrado que a relação do escore de Apgar com asfixia também é pobre nos recém-nascidos a termo 2,13 . Thorp e colaboradores 2 analisaram a gasometria de sangue de cordão umbilical de 1924 recém-nascidos a termo, encontrando uma freqüência de 77,8% de pH arterial > 7,10 entre os neonatos deprimidos (escore de Apgar no 1°ou no 5° minuto de vida < 7).…”

Section: Resultsunclassified

“…Porém, a maioria de tais recém-nascidos nascerá vigorosa e não terá seqüelas neonatais óbvias. Em nosso estudo, a freqüência de recém-nascidos vigorosos e acidó-ticos foi de 18,3%, consistente com outros estudos 13 . Entretanto, ao se baixar o nível de anormalidade para pH <7,10, este valor caiu para 5%.…”

Section: Resultsunclassified

Evaluation of umbilical cord pH and its relationship with Apgar score in term newborn infants

Pereira¹,

Rocha²,

Procianoy³

et al. 1996

J Pediatr (Rio J)

View full text Add to dashboard Cite

The value of the Apgar score as an index of birth asphyxia has been recently questioned. The purpose of the present study is to evaluate the relationship between cord blood pH and Apgar score in term newborn infants.A cross-sectional study involving 76 term newborn infants was performed from March through September 1995 at the Obstetric Unit of Hospital de Clínicas de Porto Alegre. The blood samples were obtained from umbilical cord artery and vein at the moment of delivery.Infants were divided in three different groups according to the Apgar score: Group A (n=60): >7 at one and five minutes; Group B (n=13): < 7 at one minute and >7 at five minutes; Group C (n=3): < 7 at one and five minutes. The frequency of acidemia in Group A was 18.3% (11 newborn infants) considering arterial pH < 7.20 and 5% considering arterial pH < 7.10. Three newborn infants (23%) of Group B had arterial pH > 7.20 and nine (56.2%) had arterial pH > 7.10. None of the newborn infants in Group C had arterial pH > 7.10. The sensitivity and specificity values for Apgar score less than 7 at one minute for detection of fetal acidemia were, respectively, 54.1% and 94.1%. This study confirms a poor correlation between Apgar score and umbilical blood cord pH, even in a term newborn, and emphasizes the importance of obtaining umbilical cord pH to consider the diagnosis of perinatal asphyxia.J. pediatr. (Rio J.). 1996; 72(3):139-142: umbilical blood cord pH, Apgar score, asphyxia. ResumoO valor do escore de Apgar como índice para avaliação de asfixia perinatal tem sido questionado. O presente estudo pretende relacionar o pH da artéria e da veia umbilicais com o escore de Apgar em recém-nascidos a termo.Foi realizado um estudo transversal, envolvendo 76 recém-nascidos a termo, no Centro Obstétrico do Hospital de Clínicas de Porto Alegre, no período de março a setembro de 1995. As amostras sangüíneas foram obtidas de sangue de artéria e veia umbilicais no momento do parto.Separou-se a população estudada em 3 grupos, de acordo com o escore de Apgar: Grupo A (n=60): > 7 no 1° e 5° minutos; Grupo B (n=13): < 7 no 1° e > 7 no 5° minuto; Grupo C (n=3) < 7 no 1° e 5° minutos. A freqüência de acidemia nos recém-nascidos do Grupo A foi de 18,3% (11 recém-nascidos), para pH arterial < 7,20 e 5% (3 recém-nascidos) para pH arterial < 7,10. Três recém-nascidos (23%) do Grupo B apresentaram pH arterial > 7,20 e nove (56,2%), pH arterial > 7,10. Nenhum recém-nascido do Grupo C apresentou pH arterial > 7,10. A sensibilidade e a especificidade para Apgar menor que 7 no 1°m inuto, na detecção de acidemia fetal foram, respectivamente, 54,1 e 94,1%. Este trabalho confirma que há baixa correlação do escore de Apgar com o pH do sangue de cordão, mesmo em recém-nascidos a termo, e ressalta a importância de se obter essa medida ao se definir asfixia perinatal.J. pediatr. (Rio J.). 1996; 72(3):139-142:pH do cordão umbilical, escore de Apgar, asfixia. IntroduçãoO escore de Apgar foi introduzido em 1953 por Virgí-nia Apgar 1 e, desde lá, constitui-se no método mais emp...

show abstract

Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction

Cited by 232 publications

References 9 publications

Cord blood sampling at delivery: do we need to always collect from both vessels?

Cord blood sampling at delivery: do we need to always collect from both vessels?

Compensatory rebound of body movements during sleep, after asphyxia in neonatal rats

Evaluation of umbilical cord pH and its relationship with Apgar score in term newborn infants

Contact Info

Product

Resources

About