Systematic pH-measurements in the umbilical artery: Causes and predictive value of neonatal acidosis

Lauener, P. A.; Calame, A; Janeček, Petr; Bossart, H.; Monod, J. F.

doi:10.1515/jpme.1983.11.6.278

Cited by 26 publications

(9 citation statements)

References 33 publications

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“…Two recent studies in vitro, however, have shown that neurons rapidly adapt to local acidosis, and during hypoxia show better survival if the pH is lowered (3 1, 32). Although these studies may not fully reflect the situation during acute asphyxia, clinical studies of asphyxia neonatorum have also shown that cord blood pH is a poor predictor of neurologic outcome (33)(34)(35)(36). The significance of the systemic base deficit in this study is probably a reflection of the cerebral oxygen deficit, but might also be mediated by cardiac effects as discussed above.…”

Section: Discussionmentioning

confidence: 72%

Cerebral Histologic and Electrocorticographic Changes after Asphyxia in Fetal Sheep

et al. 1992

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ABSTRACT. Asphyxia can cause neurologic damage in the fetus, but there are few data relating severity or duration of asphyxia to the degree of cerebral damage. We report cerebial histologic and electrophysiologic changes after as~hvxia in chronicallv instrumented late-gestation fetal sheep: We reduced uteiine blood flow to an ascending aortic blood oxygen content < 1.5 mM for either 30 or 60 min (n = 13). In a subsequent protocol (n = 6), if full occlusion of the common uterine artery for 15 min did not reduce the EEG voltage to less than 20% of baseline, supplementary maternal hypoxia was added for a maximum of 120 min. Histologic outcome was assessed 3 d postinsult. Uterine artery occlusion resulted in severe hypoxemia, hypercarbia, acidosis, and an initial hypertension and bradycardia. Eight of 14 surviving fetuses showed neuronal damage, with greatest loss in the parasagittal cortex, striatum, and the CA% region of the hippocampus. Neuronal damage was strongly associated with the percentage of decrease in blood pressure during the insult ( r = 0.75, p < 0.005) but not with the degree of hypoxia.No other factor was independently predictive, but, when considered separately, pH ( r = 0.54; p < 0.05) and loss of intensity of the EEG ( r = 0.61, p < 0.02) at the end of asphyxia were also correlated with outcome. The pH fell to ~7 . 0 in six of eight fetuses with damage, whereas it remained >7.0 in five of six without damage ( p < 0.05).We conclude that severe intrauterine asphyxia for periods of 30 to 120 min can cause predominant parasagittal neuronal death and that this is associated with hypotension, severe metabolic acidosis, and suppression of EEG during the insult. These data are consistent with the suggestion that impairment of cerebral perfusion is a critical event in localizing cerebral damage during perinatal asphyxia. to the degree of cerebral damage (5, 6). Indeed, there remains considerable controversy regarding the factors that contribute to perinatal hypoxic ischemic encephalopathy. We therefore examined the histologic and electrophysiologic changes associated with asphyxia due to uterine artery occlusion of varying duration in fetal sheep. MATERIALS AND METHODSPregnant sheep from 1 19 to 128 d of gestation (term is 147 d) were instrumented under 2% halothane anesthesia with an adjustable occluder, made from Teflon-lined cardiac catheterization introducers and catheters, around the maternal common uterine artery. The ovarian arteries were ligated just proximal to the ovaries to prevent anastomotic perfusion. The fetus was then instrumented as previously described (7, 8). Polyvinyl catheters were inserted into fetal ascending aortic arteries and the amniotic cavity. Two pairs of shielded stainless steel recording electrodes were placed over the parietal dura, 10 mm lateral to bregma, and 5 mm and 15 mm anterior. In seven fetuses, a pair of stimulating electrodes was also placed 15 mm lateral and 10 mm anterior to bregma. Electrocardiographic electrodes were placed s.c. over the shoulders. In the fir...

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Section: Discussionmentioning

confidence: 72%

Cerebral Histologic and Electrocorticographic Changes after Asphyxia in Fetal Sheep

et al. 1992

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“…Prague, Czechoslovakia, September [1][2][3][4][5][6]1986 The program of the Meeting will consist of sym posia. workshops, round-table discussions, poster ses sions and plenary lectures devoted to all areas of neurochemistry and molecular ncurobiology including the neuropathological and neuropharmacological ascpects.…”

Section: Announcement 6th General Meeting Of the European Society Formentioning

confidence: 99%

“…to cerebral damage [1][2][3]. Neonatal brain ul trasonography has proved accurate for the detection of intracerebral hemorrhage [4][5][6][7], posthemorrhagic ventricular dilatation [8.…”

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Interaction between Perinatal Brain Damage and Processes of Normal Brain Development

Calame¹,

Fawer²,

Anderegg

et al. 1985

Dev Neurosci

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A systematic ultrasonographic study and a prospective neurodevelopmental assessment were carried out in a population of high-risk neonates. In group A (82 preterm infants of 34 weeks gestation or less), periventricular-intraventricular hemorrhage (PVH) and periventricular leukomalacia (PVL) were the commonest lesions. The association of PVH, PVL and ventricular dilatation had a variable outcome and the prognosis was found to be poorer in the presence of diffuse or extensive PVL. In group B (115 neonates of more than 34 weeks gestation), miscellaneous ultrasound changes were observed (malformations, infections, hemorrhages and hypoxic-ischemic lesions). Malformations, hypoxic-ischemic damage and prenatal infections had a gloomy prognosis. The main targets of hypoxic-ischemic damage in the immature infant were the germinal layer and the periventricular white matter, while in the mature infant the cortex and basal ganglia were more vulnerable. A relation between the localization and the size of the lesion could be established. In conclusion, basic forms of cerebral damage should therefore be understood in terms of brain maturation, type and timing of the insult, extent and localization of the lesion.

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“…Although the 5-min Apgar score and umbilical artery pH provide data which can facilitate early newborn management [1][2], few studies have com pared these two assessments independently and in com bination on large sample sizes of patients. The purpose of this study was to investigate the independent and combined relationships between arterial cord pH and 5-min Apgar score in predicting neonatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Association between Umbilical Artery Cord pH, Five-Minute Apgar Scores and Neonatal Outcome

Anyaegbunam

Fleischer

Whitty

et al. 1991

Gynecol Obstet Invest

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A prospective study was conducted of 270 intrapartum patients admitted in labor to investigate the independent and combined relationships between umbilical arterial cord pH and Apgar scores and neonatal outcome. The results revealed that when assessed independently, a low 5-min Apgar score (< 7) was associated with both NICU admission and neonatal sepsis. When categorized by both cord pH and 5-min Apgar, the majority of patients (75.9%) had both parameters normal, 20.7% had an abnormal pH (< 7.20) and normal Apgar (> 7) and few patients had either both normal or an abnormal Apgar given a normal pH. Given a normal 5-min Apgar score, additional information about the cord pH did not enhance the predictability for either NICU admission or neonatal sepsis. Neonates with both an abnormal pH and 5-min Apgar had the highest incidence of NICU admission. For all neonates, the presence of meconium greatly increased the likelihood of being admitted to the NICU.

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Systematic pH-measurements in the umbilical artery: Causes and predictive value of neonatal acidosis

Cited by 26 publications

References 33 publications

Cerebral Histologic and Electrocorticographic Changes after Asphyxia in Fetal Sheep

Cerebral Histologic and Electrocorticographic Changes after Asphyxia in Fetal Sheep

Interaction between Perinatal Brain Damage and Processes of Normal Brain Development

Association between Umbilical Artery Cord pH, Five-Minute Apgar Scores and Neonatal Outcome

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