The Significance of Base Deficit in Acidemic Term Neonates

Abstract

(Am J Obstet Gynecol. 2015;213(3):373.e1–e7) A lack of oxygen during the intrapartum period is a well-known and significant factor leading to cerebral palsy and mortality in infants. The degree of risk can be estimated after delivery by examining pH levels in the umbilical artery. An arterial pH of <7.00 along with a base deficit of 12 mmol/L or higher is believed to be particularly significant in predicting morbidity. The authors of this study have attempted to evaluate this association, hypothesizing that the level of arterial base deficit does not have any extra predictive value in acidemic neonates beyond what can be learned from the arterial pH.

ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta‐analysis of randomized trials

“…Only 22% of all cases with encephalopathy and seizures or death had a pH <7.00 (37). Another study from the same group showed that an arterial pH <7.00 significantly predicted neonatal outcomes (38), but the addition of BD (ecf) did not improve the prediction. It is also important to know that similar cord gases may have very different outcomes.…”

“…It is also important to know that similar cord gases may have very different outcomes. The relation between cord pH values of 7.00 and 7.10 is much less clear (38).…”

Arteriovenous differences in cord blood gas analysis and the prediction of adverse neonatal outcome

“…An established dataset was used . This was an observational cohort study of non‐anomalous (confirmed at postnatal discharge) singleton deliveries, at 36 +0 or more weeks' gestation, where complete and validated cord blood gas analyses were recorded.…”

“…The sampling technique involved double clamping at least 10 cm of cord immediately after delivery and taking samples in pre‐heparinized syringes and processing them within 15 min. Collection of cord gases and exclusion of unphysiological cord pH values was as previously described . Because of the logarithmic nature of pH, AV differences in H + ion concentration were used instead of pH.…”

“…Arterial pH (ApH) is the most commonly used measure to assess the severity of the asphyxia insult and is well established as a useful predictor . Arterial base deficit is commonly used in addition, although it has recently been demonstrated that although a good predictor of adverse outcome , it does not add to the predictive value of ApH . Lactate as a measure of the metabolic component has been proposed .…”