| Relation between umbilical cord blood pH, base deficit, lactate, 5-minute Apgar score and development of hypoxic ischemic encephalopathy. | |
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MedLine Citation:
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PMID: 20846059 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Umbilical cord acid-base analysis is fundamental for assessing intrapartum hypoxia. The accuracy of arterial umbilical cord blood lactate, pH and base deficit to reflect a low 5-minute Apgar score and hypoxic ischemic encephalopathy (HIE) stage 2-3 was assessed, and new gestational age-adjusted reference standards were compared with traditional stationary reference values. DESIGN AND SAMPLE: A total of 13,735 pH-validated routine cord acid-base values from singleton deliveries were tested with stationary and gestational age-adjusted reference values using receiver operating characteristic curves and calculation of area under curve. SETTING: University hospital. MAIN OUTCOME MEASURES: Accuracy of low pH, high base deficit and high lactate, alone or in combination, to imply 5-minute Apgar score < 7 or < 4 or HIE. RESULTS: Gestational age-adjusted values were for all parameters significantly better than crude values to indicate Apgar score < 7. For Apgar score < 4, the differences were not significant. The frequency of HIE was 0.046%, making statistical analyses pointless. Gestational age-adjusted lactate had the overall best accuracy and among combinations; a low age-adjusted pH plus high age-adjusted lactate was slightly better than a low age-adjusted pH plus high age-adjusted base deficit. The sensitivity and positive predictive value were low for all parameters. CONCLUSIONS: Lactate in cord arterial blood at birth is at least as good as base deficit to reflect an impaired condition at birth, and best when gestational age-adjusted values are used. Due to methodological confounding involved in calculation of base deficit, lactate may replace base deficit as an acid-base outcome parameter at birth. |
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Authors:
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Nana Wiberg; Karin Källén; Andreas Herbst; Per Olofsson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Acta obstetricia et gynecologica Scandinavica Volume: 89 ISSN: 1600-0412 ISO Abbreviation: Acta Obstet Gynecol Scand Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-17 Completed Date: 2010-09-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370343 Medline TA: Acta Obstet Gynecol Scand Country: England |
Other Details:
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Languages: eng Pagination: 1263-9 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden. nana.wiberg@med.lu.se |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Apgar Score* Carbon Dioxide / blood Female Fetal Blood / chemistry* Humans Hydrogen-Ion Concentration Hypoxia-Ischemia, Brain / blood*, etiology, physiopathology Infant, Newborn Lactic Acid / blood Predictive Value of Tests Pregnancy ROC Curve |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide; 50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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