Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia

Robert L. Andres, George Saade, L. C. Gilstrap, I. Wilkins, A. Witlin, F. Zlatnik, Gary Hankins

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

OBJECTIVE: Our purpose was to correlate umbilical artery blood gas parameters with neonatal death and indicators of morbidity in neonates with pathologic fetal acidemia (pH <7.0). STUDY DESIGN: We reviewed maternal and neonatal charts of 93 neonates with an umbilical artery pH <7.0 who were delivered at 2 university-based centers. The relationships between umbilical artery pH, PO2, PCO2, bicarbonate, base deficit, and neonatal variables - death, need for intubation, cardiopulmonary resuscitation, seizures, hypoxic- ischemic encephalopathy, respiratory distress syndrome, intraventricular hemorrhage, meconium, sepsis, and intrauterine growth restriction - were determined with the Student t test, Mann-Whitney U test, and multiple logistic regression analysis. Data are presented as either median with 25th- 75th percentiles or mean ± SD. RESULTS: The mean gestational age at delivery was 37.9 ±3.6 weeks, and the mean birth weight was 3003 ±866 g. There was no relationship between neonatal death, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, meconium, sepsis, and any umbilical artery blood gas parameter. The PO2 was not related to any of the variables studied. A lower umbilical artery pH was associated with hypoxic-ischemic encephalopathy (6.69 vs 6.93, P = .03), cardiopulmonary resuscitation (6.83 vs 6.93, P = .03), seizure (6.75 vs 6.93, P = .02), intubation (6.83 vs 6.94, P < .001), and intrauterine growth restriction (6.72 vs 6.93, P = .01). Greater mean base deficit was associated with seizure (20.6 vs 15, P = .01), intubation (18.0 vs 13.7, P < .001), cardiopulmonary resuscitation (18.5 vs 15.0, P = .03), intrauterine growth restriction (22.0 vs 14.0, P = .02), and hypoxic-ischemic encephalopathy (24.0 vs 14.5, P = .03). Arterial PCO2 was higher only in infants with hypoxic-ischemic encephalopathy (138 vs 95.5, P = .048), intubation (106.0 vs 90.5, P = .003), and cardiopulmonary resuscitation (106.5 vs 93.0, P = .04). After control for birth weight and gestational age in the multivariate analysis, base deficit and bicarbonate were independently related to death or morbidity. CONCLUSION: Our data suggest that 'pathologic' fetal acidemia is indicated by an umbilical artery pH <7.00 with a metabolic component. The metabolic component of fetal acidemia (ie, base deficit and bicarbonate) is the most important variable in subsequent neonatal morbidity. As expected, the umbilical artery PO2 has no apparent clinical utility. The ability to predict more accurately which newborn infants with fetal acidemia are at risk of having complications may lead to a more efficient implementation of preventive measures.

Original languageEnglish (US)
Pages (from-to)867-871
Number of pages5
JournalAmerican Journal of Obstetrics and Gynecology
Volume181
Issue number4
DOIs
StatePublished - 1999

Fingerprint

Umbilicus
Umbilical Arteries
Gases
Brain Hypoxia-Ischemia
Newborn Infant
Morbidity
Cardiopulmonary Resuscitation
Intubation
Bicarbonates
Meconium
Seizures
Birth Weight
Gestational Age
Sepsis
Growth
Hemorrhage
Newborn Respiratory Distress Syndrome
Necrotizing Enterocolitis
Patent Ductus Arteriosus
Nonparametric Statistics

Keywords

  • Asphyxia
  • Fetal acidemia
  • Umbilical blood gas values

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia. / Andres, Robert L.; Saade, George; Gilstrap, L. C.; Wilkins, I.; Witlin, A.; Zlatnik, F.; Hankins, Gary.

In: American Journal of Obstetrics and Gynecology, Vol. 181, No. 4, 1999, p. 867-871.

Research output: Contribution to journalArticle

Andres, Robert L. ; Saade, George ; Gilstrap, L. C. ; Wilkins, I. ; Witlin, A. ; Zlatnik, F. ; Hankins, Gary. / Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia. In: American Journal of Obstetrics and Gynecology. 1999 ; Vol. 181, No. 4. pp. 867-871.
@article{a4392c73a2824bfbbb7cb740716a38e9,
title = "Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia",
abstract = "OBJECTIVE: Our purpose was to correlate umbilical artery blood gas parameters with neonatal death and indicators of morbidity in neonates with pathologic fetal acidemia (pH <7.0). STUDY DESIGN: We reviewed maternal and neonatal charts of 93 neonates with an umbilical artery pH <7.0 who were delivered at 2 university-based centers. The relationships between umbilical artery pH, PO2, PCO2, bicarbonate, base deficit, and neonatal variables - death, need for intubation, cardiopulmonary resuscitation, seizures, hypoxic- ischemic encephalopathy, respiratory distress syndrome, intraventricular hemorrhage, meconium, sepsis, and intrauterine growth restriction - were determined with the Student t test, Mann-Whitney U test, and multiple logistic regression analysis. Data are presented as either median with 25th- 75th percentiles or mean ± SD. RESULTS: The mean gestational age at delivery was 37.9 ±3.6 weeks, and the mean birth weight was 3003 ±866 g. There was no relationship between neonatal death, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, meconium, sepsis, and any umbilical artery blood gas parameter. The PO2 was not related to any of the variables studied. A lower umbilical artery pH was associated with hypoxic-ischemic encephalopathy (6.69 vs 6.93, P = .03), cardiopulmonary resuscitation (6.83 vs 6.93, P = .03), seizure (6.75 vs 6.93, P = .02), intubation (6.83 vs 6.94, P < .001), and intrauterine growth restriction (6.72 vs 6.93, P = .01). Greater mean base deficit was associated with seizure (20.6 vs 15, P = .01), intubation (18.0 vs 13.7, P < .001), cardiopulmonary resuscitation (18.5 vs 15.0, P = .03), intrauterine growth restriction (22.0 vs 14.0, P = .02), and hypoxic-ischemic encephalopathy (24.0 vs 14.5, P = .03). Arterial PCO2 was higher only in infants with hypoxic-ischemic encephalopathy (138 vs 95.5, P = .048), intubation (106.0 vs 90.5, P = .003), and cardiopulmonary resuscitation (106.5 vs 93.0, P = .04). After control for birth weight and gestational age in the multivariate analysis, base deficit and bicarbonate were independently related to death or morbidity. CONCLUSION: Our data suggest that 'pathologic' fetal acidemia is indicated by an umbilical artery pH <7.00 with a metabolic component. The metabolic component of fetal acidemia (ie, base deficit and bicarbonate) is the most important variable in subsequent neonatal morbidity. As expected, the umbilical artery PO2 has no apparent clinical utility. The ability to predict more accurately which newborn infants with fetal acidemia are at risk of having complications may lead to a more efficient implementation of preventive measures.",
keywords = "Asphyxia, Fetal acidemia, Umbilical blood gas values",
author = "Andres, {Robert L.} and George Saade and Gilstrap, {L. C.} and I. Wilkins and A. Witlin and F. Zlatnik and Gary Hankins",
year = "1999",
doi = "10.1016/S0002-9378(99)70316-9",
language = "English (US)",
volume = "181",
pages = "867--871",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia

AU - Andres, Robert L.

AU - Saade, George

AU - Gilstrap, L. C.

AU - Wilkins, I.

AU - Witlin, A.

AU - Zlatnik, F.

AU - Hankins, Gary

PY - 1999

Y1 - 1999

N2 - OBJECTIVE: Our purpose was to correlate umbilical artery blood gas parameters with neonatal death and indicators of morbidity in neonates with pathologic fetal acidemia (pH <7.0). STUDY DESIGN: We reviewed maternal and neonatal charts of 93 neonates with an umbilical artery pH <7.0 who were delivered at 2 university-based centers. The relationships between umbilical artery pH, PO2, PCO2, bicarbonate, base deficit, and neonatal variables - death, need for intubation, cardiopulmonary resuscitation, seizures, hypoxic- ischemic encephalopathy, respiratory distress syndrome, intraventricular hemorrhage, meconium, sepsis, and intrauterine growth restriction - were determined with the Student t test, Mann-Whitney U test, and multiple logistic regression analysis. Data are presented as either median with 25th- 75th percentiles or mean ± SD. RESULTS: The mean gestational age at delivery was 37.9 ±3.6 weeks, and the mean birth weight was 3003 ±866 g. There was no relationship between neonatal death, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, meconium, sepsis, and any umbilical artery blood gas parameter. The PO2 was not related to any of the variables studied. A lower umbilical artery pH was associated with hypoxic-ischemic encephalopathy (6.69 vs 6.93, P = .03), cardiopulmonary resuscitation (6.83 vs 6.93, P = .03), seizure (6.75 vs 6.93, P = .02), intubation (6.83 vs 6.94, P < .001), and intrauterine growth restriction (6.72 vs 6.93, P = .01). Greater mean base deficit was associated with seizure (20.6 vs 15, P = .01), intubation (18.0 vs 13.7, P < .001), cardiopulmonary resuscitation (18.5 vs 15.0, P = .03), intrauterine growth restriction (22.0 vs 14.0, P = .02), and hypoxic-ischemic encephalopathy (24.0 vs 14.5, P = .03). Arterial PCO2 was higher only in infants with hypoxic-ischemic encephalopathy (138 vs 95.5, P = .048), intubation (106.0 vs 90.5, P = .003), and cardiopulmonary resuscitation (106.5 vs 93.0, P = .04). After control for birth weight and gestational age in the multivariate analysis, base deficit and bicarbonate were independently related to death or morbidity. CONCLUSION: Our data suggest that 'pathologic' fetal acidemia is indicated by an umbilical artery pH <7.00 with a metabolic component. The metabolic component of fetal acidemia (ie, base deficit and bicarbonate) is the most important variable in subsequent neonatal morbidity. As expected, the umbilical artery PO2 has no apparent clinical utility. The ability to predict more accurately which newborn infants with fetal acidemia are at risk of having complications may lead to a more efficient implementation of preventive measures.

AB - OBJECTIVE: Our purpose was to correlate umbilical artery blood gas parameters with neonatal death and indicators of morbidity in neonates with pathologic fetal acidemia (pH <7.0). STUDY DESIGN: We reviewed maternal and neonatal charts of 93 neonates with an umbilical artery pH <7.0 who were delivered at 2 university-based centers. The relationships between umbilical artery pH, PO2, PCO2, bicarbonate, base deficit, and neonatal variables - death, need for intubation, cardiopulmonary resuscitation, seizures, hypoxic- ischemic encephalopathy, respiratory distress syndrome, intraventricular hemorrhage, meconium, sepsis, and intrauterine growth restriction - were determined with the Student t test, Mann-Whitney U test, and multiple logistic regression analysis. Data are presented as either median with 25th- 75th percentiles or mean ± SD. RESULTS: The mean gestational age at delivery was 37.9 ±3.6 weeks, and the mean birth weight was 3003 ±866 g. There was no relationship between neonatal death, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, meconium, sepsis, and any umbilical artery blood gas parameter. The PO2 was not related to any of the variables studied. A lower umbilical artery pH was associated with hypoxic-ischemic encephalopathy (6.69 vs 6.93, P = .03), cardiopulmonary resuscitation (6.83 vs 6.93, P = .03), seizure (6.75 vs 6.93, P = .02), intubation (6.83 vs 6.94, P < .001), and intrauterine growth restriction (6.72 vs 6.93, P = .01). Greater mean base deficit was associated with seizure (20.6 vs 15, P = .01), intubation (18.0 vs 13.7, P < .001), cardiopulmonary resuscitation (18.5 vs 15.0, P = .03), intrauterine growth restriction (22.0 vs 14.0, P = .02), and hypoxic-ischemic encephalopathy (24.0 vs 14.5, P = .03). Arterial PCO2 was higher only in infants with hypoxic-ischemic encephalopathy (138 vs 95.5, P = .048), intubation (106.0 vs 90.5, P = .003), and cardiopulmonary resuscitation (106.5 vs 93.0, P = .04). After control for birth weight and gestational age in the multivariate analysis, base deficit and bicarbonate were independently related to death or morbidity. CONCLUSION: Our data suggest that 'pathologic' fetal acidemia is indicated by an umbilical artery pH <7.00 with a metabolic component. The metabolic component of fetal acidemia (ie, base deficit and bicarbonate) is the most important variable in subsequent neonatal morbidity. As expected, the umbilical artery PO2 has no apparent clinical utility. The ability to predict more accurately which newborn infants with fetal acidemia are at risk of having complications may lead to a more efficient implementation of preventive measures.

KW - Asphyxia

KW - Fetal acidemia

KW - Umbilical blood gas values

UR - http://www.scopus.com/inward/record.url?scp=0032697160&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032697160&partnerID=8YFLogxK

U2 - 10.1016/S0002-9378(99)70316-9

DO - 10.1016/S0002-9378(99)70316-9

M3 - Article

C2 - 10521744

AN - SCOPUS:0032697160

VL - 181

SP - 867

EP - 871

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 4

ER -