Schwere peripartale Azidosen (NApH ≤ 7,00) - Klinik und Therapie

Abstract

Severe neonatal acidosis, defined in this study as a pH of 7,00 or less in the blood of the umbilical artery occurred in 0,4% of 8 992 life born term babies between 1980 and 1981. Analysis of high risk factors during pregnancy showed no difference between acidotic and non acidotic newborns, whereas in all newborns with severe acidosis there were more or less unexpected acute complications during delivery, such as abrutio placenta or cord complications or else. 60% of infants were born by cesarian section or forceps. Resuscitation was performed in an aggressive manner by starting IPPV within one minute post partum, correcting the acidosis and by attempting to stabilize circulation by administration of glucose and human albumin. 6 babies required prolonged ventilatory support over 24 hours. 27 newborns received parenteral solutions of glucose and amino-acids for 6 or more days. Severe acidosis was followed in 8 babies by abnormal neurologic symptoms. In infants with severe acidosis Apgar-score at one minute was not found to be significantly related to subsequent outcome. A NapH of less than or equal to 6,90 and/or Apgar-score of less than or equal to 4 at five minutes, especially in connection with additional risk factors, is an ominous finding.