Umbilical artery <scp>pH</scp> and base excess at birth are poor predictors of neurodevelopmental morbidity in early childhood

Leinonen, Elina; Gissler, Mika; Haataja, Leena; Andersson, Sture; Rahkonen, Petri; Rahkonen, Leena; Metsäranta, Marjo

doi:10.1111/apa.14812

Cited by 10 publications

(18 citation statements)

References 27 publications

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“…Umbilikal kordda hem pH hem de BE tüm GH'lerinda değerlendiren geniş serili retrospektif bir çalışmada, pH <7,00 ve BE <-16 olmasının mortalite ile ilişkili olduğu belirtilmiştir. Ancak bu eşik değerlerin serebral palsi ile ilişkisi gösterilememiştir (24). Zaigham ve ark.…”

Section: Discussionunclassified

“…Sonuçlarımızda ise mortaliteyi değerlendirmek için en güçlü kan gazı parametresinin BE olduğu bulunmuştur. Hastaların klinik sonuçlarını öngörmede BE'nin tek başına kullanılması yerine, pH ile beraber kullanılması klinik anlamlılık değerini artırmaktadır (24). Ancak kan gazı parametreleri bir bütün olduğundan tüm parametreleri beraber değerlendirmek klinik sonuçlar hakkında fikir sahibi olmak için daha anlamlı olabilir (5).…”

Section: Discussionunclassified

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Evaluation of Umbilical Cord Blood Gas Parameters in the Prediction of Mortality in Extremely Premature Infants

Yildiz¹,

Çakır²,

Tugcu³

et al. 2022

jcp

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Giriş: Doğumda umbilikal kord kan gazı değerleri yenidoğanın asit-baz dengesini gösteren en iyi yöntemdir. Term ve geç preterm bebeklerde kan gazı değerleri yenidoğanın klinik sonuçları hakkında bilgi verirken aşırı prematürelerde bu değerlerin kullanımı açık değildir. Bu çalışmada <29 gebelik haftasında (GH) doğan preterm bebeklerde umbilikal kord kan gazı değerlerinin mortalite ile ilişkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya GH <29 hafta olan bebekler dahil edilmiştir. Çalışmamız retrospektif olarak gerçekleştirilmiştir. Çalışmaya dahil edilen hastalarda kaybedilen ve yaşayan gruplarda umbilikal kord gazı (pH: potansiyel hidrojen, pCO 2 : parsiyel karbondioksit basıncı, HCO 3 : bikarbonat, BE: baz fazlası) değerleri, demografik özellikler ve klinik sonuçlar karşılaştırıldı. Bulgular: Kaybedilen 54 ve yaşayan 292 hasta olmak üzere çalışmaya toplam 346 hasta dahil edildi. Sonuçlarımıza göre <29 GH olan prematürelerde mortalite oranı %15,6 (54/346) olarak tespit edildi. Yaşamını kaybeden grupta yaşayanlara göre GH ve doğum ağırlığı daha düşük bulundu (sırasıyla, p<0,001, p<0,001). Aynı zamanda yaşayanlara göre pH, HCO 3 ve BE değerleri de kaybedilenler grubunda daha düşüktü (sırasıyla; p<0,001, p<0,001, p<0,001). Gruplar arasında pCO 2 değerleri açısından sonuçlar benzer bulundu (p=0,270). Mortalite için eşik pH değeri ≤7,18 [area under curve (AUC): 0,627], eşik HCO 3 değeri ≤19,3 mmol/L (AUC: 0,950) ve eşik BE değeri ≤-8,1 mmol/L (AUC: 0,969) olarak tespit edildi. Sonuç: GH <29 doğan prematüre bebeklerde umbilikal kord kan gazında mortalite göstergesi için en değerli parametreler HCO 3 ve BE'dir.

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Section: Discussionunclassified

Evaluation of Umbilical Cord Blood Gas Parameters in the Prediction of Mortality in Extremely Premature Infants

Yildiz¹,

Çakır²,

Tugcu³

et al. 2022

jcp

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“…The Doppler indices measured from the ductus venosus, umbilical arteries, cerebro-placental, and umbilico-cerebral Doppler ratios have been shown to correlate with the well-being of fetal growth restriction, which includes umbilical artery blood pH [7][8][9]. Umbilical artery pH (UA pH) is essential for assessing adverse pregnancy outcomes since it predicts the risk that neurodevelopmental problems will manifest in childhood [10]. There is a redistribution of fetal circulation in situations of FGR, so the Doppler ductus venous ow is changed, ranging from an increased pulsatility index to the absence or reversal of the A wave.…”

Section: Introductionmentioning

confidence: 99%

Added value of the pulmonary vein pulsatility index and its correlation to neonatal umbilical artery pH in fetal growth restrictions: A Vietnamese matched cohort study

Pham

Tran

Pham

et al. 2023

Preprint

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Background: In clinical obstetrics, many guidelines recommended the use of Doppler fetal ductus venosus blood flow to monitor and to manage fetal growth restriction (FGR). The ductus venosus and the pulmonary venous flow pattern of fetuses are similar. Umbilical artery pH (UA pH) is essential in identifying adverse pregnancy outcomes, particularly in fetal growth restriction cases. Nevertheless, the literature indicates that the relationship between pulmonary vein pulsatility index (PVPI) and UA pH in FGR cases has not been well investigated. This study aimed to identify the alteration in PVPI in FGR cases and evaluate the correlation between PVPI and UA pH in FGR newborns. Methods: This matched cohort study of singleton pregnancies from 28+0 to 40+0 weeks of gestation without congenital abnormalities included 135 cases of FGR (disease group) and 135 cases of normal growth (control group). The PVPI was measured at the proximal segment of the right or left pulmonary vein, approximately 5 mm from the left atrium wall. The umbilical artery pulsatility index (UAPI) was measured on the free umbilical cord. An elective cesarean section or labor induction are both options for ending the pregnancy, depending on the condition of the mother or fetus. Umbilical artery blood samples were collected within 5 minutes of delivery for UA pH measurement. SPSS version 20 and Medcalc version 20.1 were used for data analysis. Results: FGR cases had a significantly higher mean fetal PVPI than the control group (1.16 ± 0.26 vs. 0.84 ± 0.16; p < 0.01), and PVPI and UAPI were positively correlated (r = 0.63; p < 0.001). PVPI and UA pH were negatively correlated in FGR patients, with r = -0.68; p < 0.001. The PVPI value on the 95th percentile had a prognostic value of UA pH < 7.20 with a sensitivity of 88.2%, specificity of 66.3%, positive predictive value of 46.9%, and negative predictive value of 94.3%. Conclusions: There was a statistically significant difference in PVPI values in FGR cases compared to the normal growth group, a positive correlation between PVPI and UAPI, and a negative correlation between PVPI and UA pH. PVPI might have a prognostic meaning in predicting UA pH at birth.

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“…Regarding long-term morbidity, Leinonen et al [15] carried out a population-based study and reported that APGAR scores < 4 are a better predictor of neurologic morbidity compared to those of the lower cutoff values of cord blood analysis. Kayani et al [16] compared children aged 2 years who had umbilical vein pH below 7.00 and normal APGAR, with that of controls with both normal pH and APGAR.…”

Section: Introductionmentioning

confidence: 99%

Association of maternal, fetal and labor variables with a low Apgar score in the fifth minute in term pregnancy: a case–control study

Machado

Pinto

Gerencer

et al. 2022

Arch Gynecol Obstet

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Purpose To search for maternal, labor-related and fetal variables associated with low Apgar in the fifth minute in term pregnancy. Methods A retrospective case-control study with term births was conducted in a public teaching hospital from 2013 to 2020. Cases were term births with Apgar score less than 7 in the fifth minute, and controls, the next one or two births following a case, with Apgar of 7 or more. Non-cephalic presentations, multiples and malformations were excluded. We accessed 100 cases and 190 controls. We considered significant values of p < 0.05. Results Were accessed 27 variables which could be risk factors, from which 12 were associated with the outcome. We found a protective effect of prelabor cesarean for the outcome, odds ratio (OR) 0.38, p = 0.013. Consequently, we conducted two sets of analyses: in the whole group and in the group of laboring women. The values of OR were in general greater in the group of laboring women, compared with the whole group. We conducted multivariate analysis within the group of women in labor. The variables which fitted best in the model were nulliparity, male sex of the fetus, less than six prenatal visits and abnormal cardiotocography; all remained significant. An association of rupture of membranes more than 360 min with the outcome, even after controlling fpr duration of labor, was found; adjusted OR 2.45, p = 0.023. Conclusion Twelve variables were associated with the outcome. Prelabor cesarean had a protective effect. The time of ruptured membranes was associated with low Apgar. Keywords Low Apgar term • Rupture of membranes • Fetal distress • Neonatal morbidity • Mode of delivery What does this study add to the clinical work?Prelabor cesarean is protective against low Apgar in term. Most of cases of low Apgar in term come from pregnancies without maternal diseases.Time of ruptured membranes is associated with low Apgar in term.

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Umbilical artery pH and base excess at birth are poor predictors of neurodevelopmental morbidity in early childhood

Cited by 10 publications

References 27 publications

Evaluation of Umbilical Cord Blood Gas Parameters in the Prediction of Mortality in Extremely Premature Infants

Evaluation of Umbilical Cord Blood Gas Parameters in the Prediction of Mortality in Extremely Premature Infants

Added value of the pulmonary vein pulsatility index and its correlation to neonatal umbilical artery pH in fetal growth restrictions: A Vietnamese matched cohort study

Association of maternal, fetal and labor variables with a low Apgar score in the fifth minute in term pregnancy: a case–control study

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