pH, base deficit or lactate. Which is better for predicting neonatal morbidity?

Gamboa, Sabina Martí; Mancho, Jara Pascual; Rodríguez, María Rodrigo; Sada, Julia Ruiz; Mateo, Sergio Castán

doi:10.1080/14767058.2016.1248936

Cited by 12 publications

(12 citation statements)

References 24 publications

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“…Westgren et al 9 used centiles to create own cut‐off values for umbilical cord gas pH and lactate, and found them comparable in their ability to predict neonatal morbidity. However, there is a large span in reported means and suggested lactate cut‐offs in the literature, ranging from 3.9 to 10 mmol/L 4,5,9‐11 . Reasons for this might include different gestational ages of the contributing pregnancies, different ways of calculating cut‐offs, different rates of delivery modes (eg emergency cesarean sections, and instrumental or spontaneous vaginal delivery) or different time intervals from delivery to umbilical cord blood sampling 12 .…”

Section: Discussionmentioning

confidence: 99%

Gestational age reference ranges for umbilical cord blood lactate: An external validation study of post‐date pregnancies

Bowe

Staff

Sugulle

2020

Acta Obstet Gynecol Scand

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A previous study published in 2008 by Wiberg et al demonstrated increasing umbilical cord blood lactate at delivery by gestational age in vigorous offspring (n = 10 169, gestational age 24-43 weeks). Based on these results the authors concluded that gestational age-independent umbilical cord lactate cutoff could give false-negative or false-positive diagnosis of lacticemia. To our knowledge, these findings have not been incorporated into clinical interpretations in delivery units. To perform an external validity study for the findings by Wiberg et al, we analyzed umbilical cord blood lactate levels according to gestational age in a postdate delivery study population at our large, tertiary obstetric unit. The parallel finding of our study to that of Wiberg et al highlights the importance of using available gestational age dependent reference ranges (eg as presented in Wiberg's publication), when interpreting umbilical cord blood lactate levels for fetal wellbeing. K E Y W O R D S blood gas analyses, gestational age, lactate, pregnancy, reference range, umbilical cord blood This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Discussionmentioning

confidence: 99%

Gestational age reference ranges for umbilical cord blood lactate: An external validation study of post‐date pregnancies

Bowe

Staff

Sugulle

2020

Acta Obstet Gynecol Scand

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“…described the "acidosis paradox": newborns without acidaemia at birth might still develop a hypoxic condition. Indeed, in newborns with a normal pH might occur adverse outcomes [8,9]. Our study analysed BGA to understand if the umbilical blood acidaemia was predictive for RDS in newborns with reassuring Apgar Score > 7 at 5 min.…”

Section: Introductionmentioning

confidence: 99%

Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score

et al. 2020

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Background: Neonatal acidaemia at birth can increase neonatal morbidity and mortality and it is predictive of neonatal asphyxia. The umbilical blood gas analysis is a valid tool for the evaluation of neonatal acidaemia. However, umbilical cord blood gas analysis is commonly performed in high-risk situations or in the setting of Apgar scores < 7 at 5 min. Methods: A retrospective cohort study was conducted from June to December 2018 at the Department of mother's and child's health, Poliambulanza Foundation Hospital Institute. Inclusion criteria were: full term newborns with body weight appropriate for gestational age, born by vaginal delivery or caesarean section, reassuring Apgar Score > 7 at 5 min, arterial cord blood gas analysis showing pH < 7.4 or BE <-8 mmol/l or lactate > 6 mmol/l. The aim was to evaluate the predictive role of blood gas analysis for respiratory distress syndrome in newborns with reassuring Apgar Score. Results: 352 full term newborns were enrolled. Umbilical cord blood artery pH showed an association with respiratory distress syndrome (χ 2 (1) = 10,084, OR (95% CI): 3,9 × 10 − 4 (2,9 × 10 − 6 -0,048); p < 0,05). ROC curve revealed that the cut-off point of pH was 7.12, with a sensibility and specificity of 68 and 63%, respectively. Conclusions: Umbilical cord blood artery pH < 7.12 at birth is associated to respiratory distress syndrome in newborns. Blood gas analysis is an important instrument to help health care providers during assistance in the delivery room, but also to early identify newborns at high risk for respiratory distress syndrome and better manage the care of these newborns after birth.

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“…Cord blood metabolic acidosis differs from cord blood respiratory acidosis, which results in only minimal reduction in pH with no base deficit. 31 Isolated respiratory acidosis at birth suggests an impaired gas exchange of short duration, resulting in minimal hypoxia and moderate hypercapnia. It is a relatively transient state of little significance that resolves soon after the newborn starts to breathe.…”

Section: (C) Evaluation Of Fetal Hypoxia and Acidosismentioning

confidence: 99%

Umbilical Cord Blood Gases: Sampling, Evaluation, and Application for Clinicians

Kaur,

Hiranandani,

Grover

2023

Newborn

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Predicting the severity of birth asphyxia-related brain injury in newborn infants is a difficult task. Cord blood gases can be useful indices in the assessment of the impact of peripartum events. Cord blood gas parameters are particularly important because, despite all the progress in fetal monitoring, the time gap between the onset of fetal heart rate (FHR) abnormalities and birth asphyxia-related brain injury has remained difficult to predict. In this paper, we have focused on cord blood gas values in understanding the degree of compromise. These data can help determine the timing of fetal compromise prior to labor, and whether these precipitating events were acute or prolonged. When combined with some adverse clinical markers, the accuracy of low-cord pH in predicting neonatal mortality and morbidity can be even higher. Low-cord pH or eucapnic neonatal pH can also help in the surveillance of at-risk infants and in timely institution of neuroprotective therapies. We present a detailed review on sampling, evaluation, and application of cord blood gas values for clinicians.

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pH, base deficit or lactate. Which is better for predicting neonatal morbidity?

Cited by 12 publications

References 24 publications

Gestational age reference ranges for umbilical cord blood lactate: An external validation study of post‐date pregnancies

Gestational age reference ranges for umbilical cord blood lactate: An external validation study of post‐date pregnancies

Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score

Umbilical Cord Blood Gases: Sampling, Evaluation, and Application for Clinicians

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