The effect of profound umbilical artery acidemia in term neonates admitted to a newborn nursery

King, Terri A.; Jackson, Greg; Josey, A.Sue; Vedro, Debra A.; Hawkins, Helen; Burton, Kathleen McHugh; Burks, Mary N.; Yellin, Wendy M.; Laptook, Abbot R.

doi:10.1016/s0022-3476(98)70350-6

Cited by 61 publications

(26 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5,6 A cord pH less than7.0 complicates approximately 0.3% of all deliveries. 5,7 Even with this degree of acidosis, the likelihood of brain injury is low. Thus the majority of infants, that is, greater than 60%, exhibit no difficulties in the delivery room, are triaged to the regular newborn nursery, and exhibit an uncomplicated neonatal course in almost all cases.…”

Section: Defining Asphyxiamentioning

confidence: 99%

“…Thus the majority of infants, that is, greater than 60%, exhibit no difficulties in the delivery room, are triaged to the regular newborn nursery, and exhibit an uncomplicated neonatal course in almost all cases. 7 Even when infants with severe fetal acidemia are admitted to intensive care (usually because of respiratory difficulties) about 80 to 90% exhibit a benign neurologic course [8][9][10] and it is only a small percentage that progress to moderate to severe encephalopathy, that is approximately 10% of all infants delivered in the presence of severe fetal acidemia. 7,10 This resilience of the brain is in part based on the ability of the fetus to adapt to the interruption of placental blood flow to preserve cerebral perfusion and oxygen delivery.…”

Section: Defining Asphyxiamentioning

confidence: 99%

See 1 more Smart Citation

Pathogenesis of hypoxic-ischemic brain injury

Perlman

2007

J Perinatol

View full text Add to dashboard Cite

Accumulating evidence points to an evolving process of brain injury after intrapartum hypoxia-ischemia that initiates in utero and extends into a recovery period. The processes leading to cell death include necrosis or apoptosis, and result from the combined effects of cellular energy failure, acidosis, glutamate release, intracellular Ca 2 þ accumulation, generation of free radicals that serve to disrupt essential components of the cell. Many factors including the duration or severity of the insult influence the progression of cellular injury after hypoxia-ischemia. A secondary cerebral energy failure occurs from 6 to 48 h after the primary event and involves mitochondrial dysfunction secondary to extended reactions from primary insults (e.g., calcium influx, excitatory neurotoxicity and oxygen free radicals) as well as the release of circulatory and endogenous inflammatory cells/mediators that also contribute to ongoing brain injury. Strategies aimed at neuroprotection need to be comprehensive targeting the pathways leading to eventual mitochondrial injury.

show abstract

Section: Defining Asphyxiamentioning

confidence: 99%

Section: Defining Asphyxiamentioning

confidence: 99%

Pathogenesis of hypoxic-ischemic brain injury

Perlman

2007

J Perinatol

View full text Add to dashboard Cite

show abstract

“…6 Other studies have shown a poor correlation between metabolic acidosis at birth and neonatal neurological outcome, suggesting that most neurological abnormalities observed during neonatal period are due to causes other than intrapartum asphyxia. 7 When full-term neonates suffer asphyxia during labour or delivery, some may develop HIE with outcomes ranging from complete recovery to death. Caregivers of these sick neonates have been searching for predictors of outcome to facilitate parental counselling, and to provide appropriate levels of care that may include withdrawal of therapy or initiation of neuroprotective strategies.…”

Section: Introductionmentioning

confidence: 99%

Postnatal Lactate as an Early Predictor of Short-Term Outcome after Intrapartum Asphyxia

2003

View full text Add to dashboard Cite

OBJECTIVES:To compare the predictive value of pH, base deficit and lactate for the occurrence of moderate-to-severe hypoxic ischaemic encephalopathy (HIE) and systemic complications of asphyxia in term infants with intrapartum asphyxia. STUDY DESIGN:We retrospectively reviewed the records of 61 full-term neonates (Z37 weeks gestation) suspected of having suffered from a significant degree of intrapartum asphyxia from a period of January 1997 to December 2001.The clinical signs of HIE, if any, were categorized using Sarnat and Sarnat classification as mild (stage 1), moderate (stage 2) or severe (stage 3). Base deficit, pH and plasma lactate levels were measured from indwelling arterial catheters within 1 hour after birth and thereafter alongwith every blood gas measurement. The results were correlated with the subsequent presence or absence of moderate-to-severe HIE by computing receiver operating characteristic curves. RESULTS:The initial lactate levels were significantly higher (p ¼ 0.001) in neonates with moderate-to-severe HIE (mean±SD ¼ 11.09±4.6) as compared to those with mild or no HIE (mean±SD ¼ 7.1±4.7). Also, the lactate levels took longer to normalize in these babies. A plasma lactate concentration >7.5±mmol/l was associated with moderate-or-severe HIE with a sensitivity of 94% and specificity of 67%. The sensitivity and negative predictive value of lactate was greater than that of the pH or base deficit. CONCLUSIONS:The highest recorded lactate level in the first hour of life and serial measurements of lactate are important predictors of moderate-to-severe HIE.

show abstract

“…Não houve diferenças entre os dois grupos quanto à presença de alterações clínicas no período neonatal (renais, hepáti-cas, gastrointestinais ou neurológicas) 16 . Concluíram que recém-nascidos com profunda acidemia no sangue de cordão umbilical, se vigorosos e sem manifestação clínica, podem ser manejados como recém-nascidos normais.…”

Section: Discussionunclassified

“…Na nossa amostra houve diferença estatística entre os dois grupos quanto ao escore de Apgar no 1° e 5° minutos de vida, havendo uma associação entre acidemia grave e escore de Apgar baixo, semelhante ao relatado previamente 16 .…”

Section: Discussionunclassified

Clinical signs in term infants with different degrees of acidemia in cord blood

Pereira

Procianoy²,

Zatti³

et al. 1999

J Pediatr (Rio J)

View full text Add to dashboard Cite

Nenhum critério, individualmente, tem a capacidade de distinguir, imediatamente após o nascimento, qual recém-nascido asfixiado exige cuidado em uma unidade de neonatologia. A definição de asfixia perinatal inclui, além dos critérios clínicos e o escore de Apgar 1 , também achados bioquímicos como acidemia, hipoxemia e hipercapnia 2 . O pH do sangue do cordão umbilical é o indicador mais sensível de sofrimento fetal, sendo acidemia definida como pH <7,20 no sangue da artéria umbilical 3,4 . Entre- ResumoObjetivo: Verificar se o escore de Apgar aliado ao pH do sangue de cordão umbilical é suficiente para indicar qual o recém-nascido que desenvolverá comprometimento sistêmico.Métodos: Foi realizado um estudo envolvendo todos os recém-nascidos a termo, com escore de Apgar no 1º e 5º minutos <7 e pH no sangue de cordão umbilical <7,20, nascidos no Hospital de Clínicas de Porto Alegre, no período de março de 1995 a março de 1998. Foram coletadas amostras do sangue de cordão, para realização de gasometria venosa de todos os pacientes. Os recém-nascidos foram separados em dois grupos : Grupo A com pH < 7,0; Grupo B com pH > 7,0 e < 7,20. Foram avaliados quanto à presença de hipertensão pulmonar, insuficiência renal, síndrome da secreção inapropriada de hormônio antidiurético, cardiopatia isquêmica, convulsões precoces, seqüelas neurológicas no momento da alta e óbito.Resultados: Dos 25 recém-nascidos, 12 formaram o Grupo A e 13, o Grupo B. Não houve diferença significativa entre os grupos quanto ao tipo de parto, sexo, cor, e peso de nascimento. A idade gestacional foi menor no grupo B. Houve diferença significativa entre as médias do pH, pCO 2 e EB do sangue de cordão dos dois grupos (p<0,05). Houve uma associação positiva entre o pH do sangue cordão umbilical e o escore de Apgar. A única manifestação clínica que apresentou diferença estatisticamente significativa foi a presença maior de seqüelas neurológicas no momento da alta no grupo A (p<0,05).Conclusão: O escore de Apgar, mesmo aliado ao pH do sangue do cordão, não é adequado para indicar qual o recém-nascido com risco de comprometimento sistêmico. AbstractObjective: To verify if Apgar score plus umbilical cord pH are adequate to predict which newborn infant will develop multiorgan system disfunction. Methods:A study including all term newborn infants with Apgar scores in the first and fifth minutes of life < 7 and umbilical cord blood pH < 7.20 born in Hospital de Clínicas de Porto Alegre from March 1995 through March 1998 was performed. Venous umbilical cord blood was collected for blood gas analysis. Newborn infants were divided in two groups: Group A with pH < 7.0, and Group B with pH > 7.0 and < 7.20. Patients were evaluated for the presence of pulmonary hypertension, renal failure, inappropriate secretion of antidiuretic hormone, ischemic cardiopathy, early seizures, neurologic injury at hospital discharge and death.Results: Twenty five newborn infants were included in the study.Twelve formed Group A, and 13, Group B. There were no differences between bot...

show abstract

The effect of profound umbilical artery acidemia in term neonates admitted to a newborn nursery

Cited by 61 publications

References 16 publications

Pathogenesis of hypoxic-ischemic brain injury

Pathogenesis of hypoxic-ischemic brain injury

Postnatal Lactate as an Early Predictor of Short-Term Outcome after Intrapartum Asphyxia

Clinical signs in term infants with different degrees of acidemia in cord blood

Contact Info

Product

Resources

About