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Hensel D, Zahedi-Spung L, Carter EB, Cahill AG, Raghuraman N, Rosenbloom JI. The Risk of Neonatal Morbidity in Umbilical Artery Hypercarbia and Respiratory Acidosis. Am J Perinatol 2024; 41:e1001-e1007. [PMID: 36543241 DOI: 10.1055/s-0042-1759721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To test the hypothesis that elevated umbilical artery (UA) partial pressure of carbon dioxide (pCO2) is associated with neonatal morbidity and to compare the risk of neonatal morbidity with different patterns of UA acidosis. STUDY DESIGN This was a secondary analysis of a prospective cohort of term, singleton, nonanomalous deliveries with universal cord gas collection. The primary outcome was composite neonatal morbidity. Multivariable logistic regression was used to determine the relative risk (RR) for neonatal morbidity in patients with and without UA hypercarbia. A receiver operating characteristic curve determined the predictive value of pCO2 for neonatal morbidity. An additional multivariable logistic regression was used to evaluate the risk of neonatal morbidity in different patterns of UA acidosis. RESULTS UA hypercarbia was associated with an increased risk of neonatal morbidity (RR: 2.56, 95% confidence interval [CI]: [2.07, 3.17]). After adjusting for UA acidemia, this association remained significant (adjusted RR: 1.39, 95% CI: [1.05, 1.83]). UA pCO2 was less predictive of neonatal morbidity than UA pH (area under the curve [AUC]: 0.65, 95% CI: [0.62, 0.68] vs. AUC: 0.72, 95% CI: [0.69, 0.75], p < 0.01). The odds ratios for neonatal morbidity for respiratory, mixed, and metabolic acidosis compared with normal cord gases were 1.48 (95% CI: [0.88, 2.49]), 6.41 (95% CI: [3.68, 11.17]), and 7.49 (95% CI: [5.76, 9.72]), respectively, p-trend < 0.01. CONCLUSION UA hypercarbia is an independent predictor of neonatal morbidity, even in the setting of concomitant UA acidemia. UA mixed and metabolic acidosis carry significantly greater risk of neonatal morbidity compared with respiratory acidosis. KEY POINTS · UA pCO2 is associated with neonatal morbidity.. · UA respiratory acidosis is the UA cord gas pattern least associated with neonatal morbidity.. · UA pH is a superior predictor of neonatal morbidity compared with UA pCO2..
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Affiliation(s)
- Drew Hensel
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Leilah Zahedi-Spung
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Alison G Cahill
- Department of Women's Health, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Nandini Raghuraman
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Joshua I Rosenbloom
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Organization, The Hebrew University of Jerusalem, Jerusalem, Israel
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Boos V, Bührer C. Trends in Apgar scores and umbilical artery pH: a population-based cohort study on 10,696,831 live births in Germany, 2008-2022. Eur J Pediatr 2024; 183:2163-2172. [PMID: 38367065 PMCID: PMC11035475 DOI: 10.1007/s00431-024-05475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/19/2024]
Abstract
Low Apgar scores and low umbilical arterial (UA) blood pH are considered indicators of adverse perinatal events. This study investigated trends of these perinatal health indicators in Germany. Perinatal data on 10,696,831 in-hospital live births from 2008 to 2022 were obtained from quality assurance institutes. Joinpoint regression analysis was used to quantify trends of low Apgar score and UA pH. Additional analyses stratified by mode of delivery were performed on term singletons with cephalic presentation. Robustness against unmeasured confounding was analyzed using the E-value sensitivity analysis. The overall rates of 5-min Apgar scores < 7 and UA pH < 7.10 in liveborn infants were 1.17% and 1.98%, respectively. For low Apgar scores, joinpoint analysis revealed an increase from 2008 to 2011 (annual percent change (APC) 5.19; 95% CI 3.66-9.00) followed by a slower increase from 2011 to 2019 (APC 2.56; 95% CI 2.00-3.03) and a stabilization from 2019 onwards (APC - 0.64; 95% CI - 3.60 to 0.62). The rate of UA blood pH < 7.10 increased significantly between 2011 and 2017 (APC 5.90; 95% CI 5.15-7.42). For term singletons in cephalic presentation, the risk amplification of low Apgar scores was highest after instrumental delivery (risk ratio 1.623, 95% CI 1.509-1.745), whereas those born spontaneous had the highest increase in pH < 7.10 (risk ratio 1.648, 95% CI 1.615-1.682). Conclusion: Rates of low 5-min Apgar scores and UA pH in liveborn infants increased from 2008 to 2022 in Germany. What is Known: • Low Apgar scores at 5 min after birth and umbilical arterial blood pH are associated with adverse perinatal outcomes. • Prospective collection of Apgar scores and arterial blood pH data allows for nationwide quality assurance. What is New: • The rates of liveborn infants with 5-min Apgar scores < 7 rose from 0.97 to 1.30% and that of umbilical arterial blood pH < 7.10 from 1.55 to 2.30% between 2008-2010 and 2020-2022. • In spontaneously born term singletons in cephalic presentation, the rate of metabolic acidosis with pH < 7.10 and BE < -5 mmol/L in umbilical arterial blood roughly doubled between the periods 2008-2010 and 2020-2022.
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Affiliation(s)
- Vinzenz Boos
- Department of Neonatology, Newborn Research, University Hospital Zurich (USZ), University of Zurich (UZH), Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Gonen N, Cohen I, Gluck O, Jhucha D, Shmueli A, Barda G, Weiner E, Barber E. Umbilical cord blood gases sampling in low-risk vaginal deliveries as a predictor of adverse neonatal outcome. Arch Gynecol Obstet 2024; 309:523-531. [PMID: 36801967 DOI: 10.1007/s00404-023-06965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION There is no clear correlation between abnormal umbilical cord blood gas studies (UCGS) and adverse neonatal outcome in low-risk deliveries. We investigated the need for its routine use in low-risk deliveries. METHODS We retrospectively compared maternal, neonatal, and obstetrical characteristics among low-risk deliveries (2014-2022) between "normal" and "abnormal" pH groups: A:normal pH ≥ 7.15; abnormal pH < 7.15; B: normal pH ≥ 7.15 and base excess (BE) > - 12 mmol/L; abnormal pH < 7.15 and BE ≤ We retrospectively compared 12 mmol/L; C: normal pH ≥ 7.1; abnormal pH < 7.1; D: normal pH > 7.1 and BE > - 12 mmol/L; abnormal pH < 7.1 and BE ≤ - 12 mmol/L. RESULTS Of 14,338 deliveries, the rates of UCGS were: A-0.3% (n = 43); B-0.07% (n = 10); C-0.11% (n = 17); D-0.03% (n = 4). The primary outcome, composite adverse neonatal outcome (CANO) occurred in 178 neonates with normal UCGS (1.2%) and in only one case with UCGS (2.6%). The sensitivity and specificity of UCGS as a predictor of CANO were high (99.7-99.9%) and low (0.56-0.59%), respectively. CONCLUSION UCGS were an uncommon finding in low-risk deliveries and its association with CANO was not clinically relevant. Consequently, its routine use should be considered.
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Affiliation(s)
- Noa Gonen
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Ido Cohen
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Dan Jhucha
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Anat Shmueli
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halochamim 62, Holon, Tel Aviv, Israel.
- Faculty of Medicine, Tel Aviv University, 69978, Ramat Aviv, Tel Aviv, Israel.
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Cohen G, Ravid D, Gnaiem N, Gluska H, Schreiber H, Haleluya NL, Biron-Shental T, Kovo M, Markovitch O. The Impact of Total Deceleration Area and Fetal Growth on Neonatal Acidemia in Vacuum Extraction Deliveries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050776. [PMID: 37238325 DOI: 10.3390/children10050776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
We aimed to investigate the correlation between total deceleration area (TDA), neonatal birthweight and neonatal acidemia in vacuum extractions (VEs). This is a retrospective study in a tertiary hospital, including VE performed due to non-reassuring fetal heart rate (NRFHR). Electronic fetal monitoring during the 120 min preceding delivery was interpreted by two obstetricians who were blinded to neonatal outcomes. TDA was calculated as the sum of the area under the curve for each deceleration. Neonatal birthweights were classified as low (<2500 g), normal (2500-3999 g) or macrosomic (>4000 g). A total of 85 VEs were analyzed. Multivariable linear regression, adjusted for gestational age, nulliparity and diabetes mellitus, revealed a negative correlation between TDA in the 60 min preceding delivery and umbilical cord pH. For every 10 K increase in TDA, the cord pH decreased by 0.02 (p = 0.038; 95%CI, -0.05-0.00). The use of the Ventouse-Mityvac cup was associated with a 0.08 decrease in cord pH as compared to the Kiwi OmniCup (95%CI, -0.16-0.00; p = 0.049). Low birthweights, compared to normal birthweights, were not associated with a change in cord pH. To conclude, a significant correlation was found between TDA during the 60 min preceding delivery and cord pH in VE performed due to NRFHR.
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Affiliation(s)
- Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit Ravid
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nagam Gnaiem
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hadar Gluska
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hanoch Schreiber
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Ob-Gyn Ultrasound Unit, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Noa Leybovitz Haleluya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheba 8410101, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ofer Markovitch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Ob-Gyn Ultrasound Unit, Meir Medical Center, Kfar Saba 4428164, Israel
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Roberta A, Imma AC, Elena O, Tosi M, Vaianella E, Galli L, Daniela S, Valentino R. The application of intrauterine resuscitation maneuvers in delivery room: actual and expected use. Midwifery 2022; 107:103279. [DOI: 10.1016/j.midw.2022.103279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
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Biloborodova T, Scislo L, Skarga-Bandurova I, Sachenko A, Molgad A, Povoroznjuk O, Yevsieiva Y. Fetal ECG signal processing and identification of hypoxic pregnancy conditions in-utero. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:4919-4942. [PMID: 34198472 DOI: 10.3934/mbe.2021250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The fetal heart rate (fHR) variability and fetal electrocardiogram (fECG) are considered the most important sources of information about fetal wellbeing. Non-invasive fetal monitoring and analysis of fECG are paramount for clinical trials. They enable examining the fetal health status and detecting the heart rate changes associated with insufficient oxygenation to cut the likelihood of hypoxic fetal injury. Despite the fact that significant advances have been achieved in electrocardiography and adult ECG signal processing, the analysis of fECG is still in its infancy. Due to accurate fetal morphology extraction techniques have not been properly developed, many areas require particular attention on the way of fully understanding the changes in variability in the fetus and implementation of the non-invasive techniques suitable for remote home care which is increasingly in demand for high-risk pregnancy monitoring. In this paper, we introduce an integrated approach for fECG signal extraction and processing based on various methods for fetal welfare investigation and hypoxia risk estimation. To the best of our knowledge, this is the first attempt to introduce the auto-generated risk scoring in fECG to achieve early warning on fetus' safety and provide the physician with additional information about the possible fetal complications. The proposed method includes the following stages: fECG extraction, fHR and fetal heart rate variability (fHRV) calculation, hypoxia index (HI) evaluation and risk estimation. The extracted signals were examined by assessing Signal to Noise Ratio (SNR) and mean square error (MSE) values. The results obtained demonstrated great potential, but more profound research and validation, as well as a consistent clinical study, are needed before implementation into the hospital and at-home monitoring.
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Affiliation(s)
- Tetiana Biloborodova
- Department of Computer Science and Engineering, Volodymyr Dahl East Ukrainian National University, 43 Donetska Street, Severodonetsk 93400, Ukraine
| | - Lukasz Scislo
- Faculty of Electrical and Computer Engineering, Cracow University of Technology, Warszawska 24 Street, Cracow 31155, Poland
| | - Inna Skarga-Bandurova
- School of Engineering, Computing and Mathematics, Oxford Brookes University, Wheatley Campus, Oxford, OX33 1HX, UK
| | - Anatoliy Sachenko
- Department of Informatics, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom 26600, Poland
- Research Institute for Intelligent Computer Systems, West Ukrainian National University, Ternopil 46009, Ukraine
| | - Agnieszka Molgad
- Department of Informatics, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom 26600, Poland
| | - Oksana Povoroznjuk
- Department of Computer Engineering and Programming, National Technical University "Kharkiv Polytechnic Institute," 2 Kyrpychova Street, Kharkiv 61002, Ukraine
| | - Yelyzaveta Yevsieiva
- School of Medicine, V. N. Karazin Kharkiv National University, 4 Svobody Square, Kharkiv 61002, Ukraine
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Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, Braila AD, Nastase L, Bacalbasa N, Chivu LI, Furtunescu F, Ioan RG. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp Ther Med 2020; 21:80. [PMID: 33363591 DOI: 10.3892/etm.2020.9513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.
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Affiliation(s)
- Adrian Neacsu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Emergency Clinical Hospital, 042122 Bucharest, Romania
| | - Cătălin Gabriel Herghelegiu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
| | - Silviu Voinea
- Department of Surgery, Institute of Oncology 'Prof. Dr. Alexandru Trestioreanu', 020122 Bucharest, Romania
| | - Mihai Cornel Traian Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics-Gynecology, 'Sf. Pantelimon' Emergency University Hospital, 021623 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, Bucur Maternity Hospital, 012361 Bucharest, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Anca Daniela Braila
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Leonard Nastase
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
| | - Laura Ioana Chivu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Pathophysiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Raluca Gabriela Ioan
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
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Zhang S, Li B, Zhang X, Zhu C, Wang X. Birth Asphyxia Is Associated With Increased Risk of Cerebral Palsy: A Meta-Analysis. Front Neurol 2020; 11:704. [PMID: 32765409 PMCID: PMC7381116 DOI: 10.3389/fneur.2020.00704] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/09/2020] [Indexed: 01/04/2023] Open
Abstract
Objective: To assess the association between birth asphyxia—as defined by the pH of umbilical cord blood—and cerebral palsy in asphyxiated neonates ≥35 weeks' gestation. Methods: Two reviewers independently selected English-language studies that included data on the incidence of cerebral palsy in asphyxiated neonates ≥35 weeks' gestation. Studies were searched from the Embase, Google Scholar, PubMed, and Cochrane Library databases up to 31 December 2019, and the references in the retrieved articles were screened. Results: We identified 10 studies that met the inclusion criteria for our meta-analysis, including 8 randomized controlled trials and 2 observational studies. According to a random effects model, the pooled rate of cerebral palsy in the randomized controlled trials was 20.3% (95% CI: 16.0–24.5) and the incidence of cerebral palsy in the observational studies was 22.2% (95% CI: 8.5–35.8). Subgroup analysis by treatment for hypoxic ischemic encephalopathy in asphyxiated neonates showed that the pooled rates of cerebral palsy were 17.3% (95% CI: 13.3–21.2) and 23.9% (95% CI: 18.1–29.7) for the intervention group and non-intervention group, respectively. Conclusion: Our findings suggest that the incidence of cerebral palsy in neonates (≥35 weeks' gestation) with perinatal asphyxia is significantly higher compared to that in the healthy neonate population. With the growing emphasis on improving neonatal neurodevelopment and reducing neurological sequelae, we conclude that the prevention and treatment of perinatal asphyxia is essential for preventing the development of cerebral palsy.
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Affiliation(s)
- Shan Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Bingbing Li
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Xiaoli Zhang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China.,Center of Perinatal Medicine and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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9
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Santotoribio JD, Cañavate-Solano C, Quintero-Prado R, González-Macías C, Soto-Pazos E, Vilar-Sanchez Á, Mesa-Suárez P, Ramos-Ramos V, Cuadros-Muñoz JF, Mayor-Reyes M, Pérez-Ramos S, Fernández-Alba JJ. Neuroapoptosis in newborns with respiratory acidosis at birth. Clin Biochem 2019; 74:69-72. [PMID: 31473201 DOI: 10.1016/j.clinbiochem.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/11/2019] [Accepted: 08/28/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND S100B protein is one of the most accurate biomarkers for diagnosis of neuroapoptosis and brain damage. The aim was to evaluate the lactate concentration and acid-base balance (pH, pCO2, pO2, HCO3c and BEb) in umbilical cord blood to predict high risk of neuroapoptosis and analyze the relationship between the levels of these biomarkers and umbilical cord blood S100B protein concentration at birth. METHODS Apparently healthy newborns were included. S100B protein and blood gas test (lactate and acid-base balance) were determined in umbilical cord blood at birth. Newborns were classified into two groups: with and without high risk of neuroapoptosis. Newborns with high umbilical cord blood S100B protein concentration were considered newborns at high risk of neuroapoptosis. RESULTS Sixty-one newborns were included, 12 had high risk of neuroapoptosis and 49 did not. S100B protein concentration correlate directly with pCO2 levels (Rho: 0.286, p = .0321) and lactate concentration (Rho: 0.278, p = .0315); and indirectly with pH (Rho: -0.332, p = .01). The analysis of the ROC curves yielded significant curves for pH and pCO2 to predict high risk of neuroapoptosis, pH optimal cutoff value was 7.19 (sensitivity: 50%, specificity: 83.7%, AUC: 0.708); and pCO2 optimal cutoff value was 60 mmHg (sensitivity: 30%, specificity: 85.4%, AUC: 0.705). CONCLUSIONS Respiratory acidosis is associated to high concentrations of S100B protein in umbilical cord blood at birth. Umbilical cord blood pH and pCO2 may be useful in differentiating newborns at high risk of neuroapoptosis. Umbilical cord blood gas test may be valuable as risk indicator for neuroapoptosis at birth.
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Affiliation(s)
- José D Santotoribio
- Department of Laboratory Medicine, Puerto Real University Hospital, Cadiz, Spain; Department of Biomedicine, Biotechnology and Public Health, Cadiz University School of Medicine, Cadiz, Spain.
| | | | - Rocío Quintero-Prado
- Department of Obstetrics and Gynecology. Puerto Real University Hospital, Cadiz, Spain
| | - Carmen González-Macías
- Department of Obstetrics and Gynecology. Puerto Real University Hospital, Cadiz, Spain; Department of Mother-Child and Radiology, Cadiz University School of Medicine, Cadiz, Spain
| | - Estefanía Soto-Pazos
- Department of Obstetrics and Gynecology. Puerto Real University Hospital, Cadiz, Spain
| | - Ángel Vilar-Sanchez
- Department of Obstetrics and Gynecology. Puerto Real University Hospital, Cadiz, Spain
| | - Pablo Mesa-Suárez
- Department of Anesthesiology, Puerto Real University Hospital, Cadiz, Spain
| | | | - Juan F Cuadros-Muñoz
- Department of Laboratory Medicine, Puerto Real University Hospital, Cadiz, Spain
| | - María Mayor-Reyes
- Department of Laboratory Medicine, Puerto Real University Hospital, Cadiz, Spain
| | - Santiago Pérez-Ramos
- Department of Laboratory Medicine, Puerto Real University Hospital, Cadiz, Spain; Department of Biomedicine, Biotechnology and Public Health, Cadiz University School of Medicine, Cadiz, Spain
| | - Juan J Fernández-Alba
- Department of Obstetrics and Gynecology. Puerto Real University Hospital, Cadiz, Spain; Department of Mother-Child and Radiology, Cadiz University School of Medicine, Cadiz, Spain
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10
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Salah MM, Abdelmawla MA, Eid SR, Hasanin RM, Mostafa EA, Abdelhameed MW. Role of Matrix Metalloproteinase-9 in Neonatal Hypoxic-Ischemic Encephalopathy. Open Access Maced J Med Sci 2019; 7:2114-2118. [PMID: 31456835 PMCID: PMC6698126 DOI: 10.3889/oamjms.2019.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Neonatal encephalopathy is a heterogeneous syndrome characterised by signs of central nervous system dysfunction in the newborn. Matrix metalloproteinase-9(MMP-9) increases the blood-brain barrier permeability, and their inhibitors can reduce its damage. MMP-9 has been implicated specifically in cerebral ischemia. AIM To measure serum MMP-9 in neonatal hypoxic-ischemic encephalopathy and evaluate its correlation to the severity of early prediction and treatment. METHODS its case-control study. The serum concentration of MMP-9 was determined by ELISA in 100 hypoxic neonates and 50 healthy neonates of matched age and sex who served as controls. RESULTS In our present study the serum MMP-9 level was significantly higher at p = 0.0001 in hypoxic-ischemic full-term newborns (176.7 ± 68.7 ng/ml)as compared to control newborn (69.4 ± 34.85 ng/ml)and it was significantly higher at p = 0.0075 in hypoxic-ischemic preterm newborn (171.2 ± 132.9 ng/ml) when compared to control newborn (72.54 ± 36.74 ng/ml), also MMP-9 was significantly higher at Sarnat stage III at p = 0.0001. CONCLUSION Serum MMP-9 level was significantly higher in hypoxic-ischemic newborns, and significantly increased with severity, so we suggest that serum MMP-9 level is important for predicting neurological sequel and severity in neonatal encephalopathy.
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Affiliation(s)
- Mohab M. Salah
- Department of Pediatrics, National Research Centre (NRC), Cairo, Egypt
| | - MA Abdelmawla
- Department of Pediatrics, National Research Centre (NRC), Cairo, Egypt
| | - Sally R. Eid
- Department of Pediatrics, Research Institute of Ophthalmology Centre, Giza, Egypt
| | - Rasha M. Hasanin
- Department of Pediatrics, National Research Centre (NRC), Cairo, Egypt
| | - Eman A. Mostafa
- Department of Pediatrics, National Research Centre (NRC), Cairo, Egypt
| | - MW Abdelhameed
- Department of Clinical Pathology, Shobra Hospial, Cairo, Egypt
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11
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Gonen N, Gluck O, Zussman NM, Bar J, Kovo M, Weiner E. The role of umbilical cord gas studies in the prediction of adverse neonatal outcomes in scheduled nonlaboring term singleton cesarean deliveries. Am J Obstet Gynecol MFM 2019; 1:119-127. [PMID: 33345817 DOI: 10.1016/j.ajogmf.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Most major societies do not state a specific recommendation against or in favor of routine umbilical cord gas studies sampling. OBJECTIVE We aimed to study the correlation between abnormal umbilical cord gas studies (using 5 different definitions) and adverse neonatal outcomes in scheduled nonlaboring term singleton cesarean deliveries. STUDY DESIGN The medical charts, surgical records, and neonatal charts of all singleton cesarean deliveries at 370/7-416/7 weeks of gestation between January 2009 and May 2018 from a single tertiary center were reviewed. The cohort of singleton cesarean deliveries was divided into those with "normal" vs "abnormal" umbilical cord gas studies with the 5 different definitions: (1) definition A: pH ≤7.15; (2) definition B: pH ≤7.15 and base excess ≤-12 mmol/L; (3) definition C: pH ≤7.1l (4) definition D: pH ≤7.1 and base excess ≤-12 mmol/L, and (5) definition E: pH <7.0 and base excess ≤-12 mmol/L. Adverse neonatal outcomes included Apgar scores at 5 minutes ≤7, neonatal sepsis, blood transfusion, phototherapy, respiratory morbidity (presence of respiratory distress syndrome, transient tachypnea of the newborn infant, mechanical ventilation, need for respiratory support, or meconium aspiration), cerebral morbidity (presence of intraventricular hemorrhage, seizures, or hypoxic-ischemic encephalopathy), necrotizing enterocolitis, or death. Composite adverse outcome was ≥1 of the aforementioned complications. RESULTS Overall, 3001 singleton cesarean deliveries were included. The rate of abnormal umbilical cord gas studies with the use of definitions A-E was 2.6%, 0.3%, 1.2%, 0.3%, and 0.1%, respectively. The overall rate of adverse neonatal outcome for the entire cohort was 14.43% (433/3001). There was no correlation between abnormal umbilical cord gas studies and composite adverse neonatal outcome with the use of any of the definitions A-E (P=.2, P=.3, P=.2, P=.3, P=.1, respectively). The sensitivity and specificity of abnormal umbilical cord gas studies as a predictor of composite adverse neonatal outcome were calculated for each of the abnormal umbilical cord gas studies definitions; although the sensitivity was extremely low (0-2.07%), the specificity was high (97.2-99.9%) CONCLUSION: Abnormal umbilical cord gas studies are an uncommon finding in cases of singleton term singleton cesarean deliveries and do not correlate with adverse neonatal outcomes. Therefore, the clinical usefulness and cost-effectiveness of obtaining these studies routinely should be questioned.
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Affiliation(s)
- Noa Gonen
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Mevorach Zussman
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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12
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Einikyte R, Snieckuviene V, Ramasauskaite D, Panaviene J, Paliulyte V, Opolskiene G, Kazenaite E. The comparison of umbilical cord arterial blood lactate and pH values for predicting short-term neonatal outcomes. Taiwan J Obstet Gynecol 2018; 56:745-749. [PMID: 29241913 DOI: 10.1016/j.tjog.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Current clinical practice of assessing neonatal condition is based on evaluation of umbilical cord arterial blood pH value rather than lactate. However, evidence shows that lactate is direct and more predictive measurement than pH or at least of equal importance. This study is to assess and compare umbilical cord arterial lactate and pH values for predicting short-term neonatal outcomes. MATERIALS AND METHODS A retrospective cohort study was conducted at the tertiary level hospital, were arterial umbilical cord blood sampling was collected according to the standard procedures. Neonatal morbidity was registered if at least one of the following conditions was noted: Apgar score at 1 min after delivery was 6 or lower, resuscitation performed, including assisted ventilation and requirement of admission to neonatal intensive care unit. Mothers-newborns pairs were allocated into two groups: newborns exposed to perinatal hypoxia (group 1) and observed as healthy newborns (group 2). Receiver operating characteristics curves (ROC) were generated to assess the predictive ability of pH and lactate for the short-term neonatal outcomes. RESULTS 901 neonates born at ≥37 weeks of gestation were included. Newborns exposed to perinatal hypoxia (group 1) encompassed 39 (4.3%) patients, and observed as healthy (group 2) - 862 (95.7%). Arterial umbilical cord blood pH in group 1 was 7.160 ± 0.126 as compared to 7.314 ± 0.083 in group 2; p < 0.001. Mean arterial lactate was significantly higher in group 1 than group 2 (6.423 ± 2.335 as compared to 3.600 ± 1.833; p < 0.001). The difference between areas under ROC curves representing pH and lactate was not significant (0.848 and 0.831 respectively; p = 0.6132). CONCLUSION Umbilical cord arterial lactate and pH predicted short-term neonatal outcomes with similar efficacies.
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Affiliation(s)
- Ruta Einikyte
- Vilnius University, Faculty of Medicine, Vilnius 08661, Lithuania
| | - Vilija Snieckuviene
- Vilnius University, Faculty of Medicine, Clinic of Obstetrics and Gynecology, Vilnius 08661, Lithuania
| | - Diana Ramasauskaite
- Vilnius University, Faculty of Medicine, Clinic of Obstetrics and Gynecology, Vilnius 08661, Lithuania.
| | | | - Virginija Paliulyte
- Vilnius University, Faculty of Medicine, Clinic of Obstetrics and Gynecology, Vilnius 08661, Lithuania
| | - Gina Opolskiene
- Vilnius University, Faculty of Medicine, Clinic of Obstetrics and Gynecology, Vilnius 08661, Lithuania
| | - Edita Kazenaite
- Vilnius University, Faculty of Medicine, Centre of Hepatology, Gastroenterology and Dietetics, Vilnius 08661, Lithuania; Vilnius University Hospital Santara Clinics, Vilnius 08661, Lithuania
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13
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Mikkelsen SH, Olsen J, Bech BH, Wu C, Liew Z, Gissler M, Obel C, Arah O. Birth asphyxia measured by the pH value of the umbilical cord blood may predict an increased risk of attention deficit hyperactivity disorder. Acta Paediatr 2017; 106:944-952. [PMID: 28247426 DOI: 10.1111/apa.13807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/09/2016] [Accepted: 02/24/2017] [Indexed: 12/28/2022]
Abstract
AIM Although birth asphyxia is a major risk factor for neonatal and childhood morbidity and mortality, it has not been investigated much in relation to attention deficit hyperactivity disorder (ADHD). We examined whether birth asphyxia measured by the pH of the blood in the umbilical artery cord was associated with childhood ADHD. METHOD A population-based cohort of 295 687 children born in Finland between 1991 and 2002 was followed until December 31, 2007. ADHD was identified by the International Classification of Diseases, 10th edition, as a diagnosis of hyperkinetic disorder. We examined the risk of ADHD with varying pH values using Cox regression, taking time trends into consideration. RESULTS When compared to the reference group, a pH value below 7.10 was significantly associated with an increased risk of ADHD. The strongest risks were observed among children with a pH value <7.15 and a gestational age of <32 weeks. The pH value did not contribute much to the risk among children with an Apgar score of 0-3. CONCLUSION Birth asphyxia, defined by low pH value, may predict an increased risk of ADHD in childhood. The association between the pH value and ADHD was homogenous when stratified by gestational age and the Apgar score.
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Affiliation(s)
| | - Jørn Olsen
- Clinical Epidemiology; Department of Clinical Medicine; Aarhus University; Aarhus C Denmark
| | - Bodil Hammer Bech
- Department of Public Health; Section for Epidemiology; Aarhus University; Aarhus C Denmark
| | - Chunsen Wu
- Department of Obstetrics and Gynaecology; Odense University Hospital; Odense Denmark
| | - Zeyan Liew
- Department of Epidemiology; Fielding School of Public Health; University of California, Los Angeles (UCLA); Los Angeles CA USA
| | - Mika Gissler
- National Institute for Health and Welfare; Helsinki University; Helsinki Finland
| | - Carsten Obel
- Department of Public Health; Section for General Medical Practice; Aarhus University; Aarhus C Denmark
| | - Onyebuchi Arah
- Department of Epidemiology; Fielding School of Public Health; University of California, Los Angeles (UCLA); Los Angeles CA USA
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14
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Allanson ER, Pattinson RC, Nathan EA, Dickinson JE. The introduction of umbilical cord lactate measurement and associated neonatal outcomes in a South African tertiary hospital labor ward. J Matern Fetal Neonatal Med 2017; 31:1272-1278. [DOI: 10.1080/14767058.2017.1315094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E. R. Allanson
- Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Australia
- SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - R. C. Pattinson
- SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - E. A. Nathan
- Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Australia
| | - J. E. Dickinson
- Faculty of Medicine, Dentistry, and Health Sciences, School of Women's and Infants' Health, University of Western Australia, Crawley, Australia
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15
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Allanson ER, Waqar T, White C, Tunçalp Ö, Dickinson JE. Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review. BJOG 2017; 124:584-594. [PMID: 27704703 DOI: 10.1111/1471-0528.14306] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Umbilical cord lactate is one approach to measuring acidosis and intrapartum hypoxia, knowledge of which may be helpful for clinicians involved in the care of women and newborns. OBJECTIVE To synthesise the evidence on accuracy of umbilical cord lactate in measuring acidosis and predicting poor neonatal outcome. SEARCH STRATEGY Studies published and unpublished between 1990 and 2014 from PubMed/Medline, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were assessed. SELECTION CRITERIA Cross-sectional and randomised studies that assessed fetal acidosis (using lactate as the index test) with or without an assessment of neonatal outcome. DATA COLLECTION AND ANALYSIS Correlations between index and reference test(s) were recorded, as were the raw data to classify the predictive ability of umbilical lactate for neonatal outcomes. Meta-analysis of correlation was performed. We plotted estimates of the studies' observed sensitivities and specificities on Forest plots with 95% confidence intervals (CI). Where possible, we combined data using meta-analysis, applying the hierarchical summary receiver operating characteristics model and a bivariate model. MAIN RESULTS Twelve studies were included. Umbilical lactate correlated with pH [pooled effect size (ES) -0.650; 95% CI -0.663 to -0.637, P < 0.001], base excess (ES -0.710; 95% CI -0.721 to -0.699, P < 0.001), and Apgar scores at 5 minutes (ES 0.300; 95% 0.193-0.407, P < 0.001). Umbilical lactate had pooled sensitivity and specificity for predicting neonatal neurological outcome including hypoxic ischaemic encephalopathy of 69.7% (95% CI 23.8-94.4%) and 93% (95% CI 86.8-96.3%). AUTHORS' CONCLUSION Umbilical cord lactate is a clinically applicable, inexpensive and effective way to measure acidosis and is a tool that may be used in the assessment of neonatal outcome. TWEETABLE ABSTRACT Umbilical cord lactate: a clinically applicable, inexpensive, effective way to measure intrapartum acidosis.
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Affiliation(s)
- E R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - T Waqar
- CMH Medical College, CMH Lahore, Lahore, Pakistan
| | - Crh White
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Ö Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - J E Dickinson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
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16
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Endrich O, Rimle C, Zwahlen M, Triep K, Raio L, Nelle M. Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015. PLoS One 2017; 12:e0170691. [PMID: 28118380 PMCID: PMC5261744 DOI: 10.1371/journal.pone.0170691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 01/09/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The ICD-10 categories of the diagnosis "perinatal asphyxia" are defined by clinical signs and a 1-minute Apgar score value. However, the modern conception is more complex and considers metabolic values related to the clinical state. A lack of consistency between the former clinical and the latter encoded diagnosis poses questions over the validity of the data. Our aim was to establish a refined classification which is able to distinctly separate cases according to clinical criteria and financial resource consumption. The hypothesis of the study is that outdated ICD-10 definitions result in differences between the encoded diagnosis asphyxia and the medical diagnosis referring to the clinical context. METHODS Routinely collected health data (encoding and financial data) of the University Hospital of Bern were used. The study population was chosen by selected ICD codes, the encoded and the clinical diagnosis were analyzed and each case was reevaluated. The new method categorizes the diagnoses of perinatal asphyxia into the following groups: mild, moderate and severe asphyxia, metabolic acidosis and normal clinical findings. The differences of total costs per case were determined by using one-way analysis of variance. RESULTS The study population included 622 cases (P20 "intrauterine hypoxia" 399, P21 "birth asphyxia" 233). By applying the new method, the diagnosis asphyxia could be ruled out with a high probability in 47% of cases and the variance of case related costs (one-way ANOVA: F (5, 616) = 55.84, p < 0.001, multiple R-squared = 0.312, p < 0.001) could be best explained. The classification of the severity of asphyxia could clearly be linked to the complexity of cases. CONCLUSION The refined coding method provides clearly defined diagnoses groups and has the strongest effect on the distribution of costs. It improves the diagnosis accuracy of perinatal asphyxia concerning clinical practice, research and reimbursement.
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Affiliation(s)
- Olga Endrich
- Medical Directorate, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Carole Rimle
- Student at the Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Karen Triep
- Medical Directorate, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - Mathias Nelle
- Neonatology Division, Inselspital, University Hospital of Bern, Bern, Switzerland
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17
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Ahlberg M, Elvander C, Johansson S, Cnattingius S, Stephansson O. A policy of routine umbilical cord blood gas analysis decreased missing samples from high-risk births. Acta Paediatr 2017; 106:43-48. [PMID: 27689780 DOI: 10.1111/apa.13610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/01/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022]
Abstract
AIM This study compared obstetric units practicing routine or selective umbilical cord blood gas analysis, with respect to the risk of missing samples in high-risk deliveries and in infants with birth asphyxia. METHODS This was a Swedish population-based cohort study that used register data for 155 235 deliveries of live singleton infants between 2008 and 2014. Risk ratios and 95% confidence intervals were calculated to estimate the association between routine and selective umbilical cord blood gas sampling strategies and the risk of missing samples. RESULTS Selective sampling increased the risk ratios when routine sampling was used as the reference, with a value of 1.0, and these were significant in high-risk deliveries and birth asphyxia. The risk ratios for selective sampling were large-for-gestational age (9.07), preterm delivery at up to 36 weeks of gestation (8.24), small-for-gestational age (7.94), two or more foetal scalp blood samples (5.96), an Apgar score of less than seven at one minute (2.36), emergency Caesarean section (1.67) and instrumental vaginal delivery (1.24). CONCLUSION Compared with routine sampling, selective umbilical cord blood gas sampling significantly increased the risks of missing samples in high-risk deliveries and in infants with birth asphyxia.
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Affiliation(s)
- M Ahlberg
- Division of Clinical Epidemiology; Department of Medicine; Karolinska University Hospital; Stockholm Sweden
- Division of Obstetrics and Gynecology; Department of Clinical Science and Education; Karolinska Institutet, South General Hospital; Stockholm Sweden
| | - C Elvander
- Division of Clinical Epidemiology; Department of Medicine; Karolinska University Hospital; Stockholm Sweden
| | - S Johansson
- Division of Clinical Epidemiology; Department of Medicine; Karolinska University Hospital; Stockholm Sweden
| | - S Cnattingius
- Division of Clinical Epidemiology; Department of Medicine; Karolinska University Hospital; Stockholm Sweden
| | - O Stephansson
- Division of Clinical Epidemiology; Department of Medicine; Karolinska University Hospital; Stockholm Sweden
- School of Public Health; University of California; Berkeley CA USA
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18
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Gravett C, Eckert LO, Gravett MG, Dudley DJ, Stringer EM, Mujobu TBM, Lyabis O, Kochhar S, Swamy GK. Non-reassuring fetal status: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016; 34:6084-6092. [PMID: 27461459 PMCID: PMC5139811 DOI: 10.1016/j.vaccine.2016.03.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Courtney Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's Hospital, Seattle, USA.
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19
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Xiao W, Duan QF, Fu WY, Chi XZ, Wang FY, Ma DQ, Wang TL, Zhao L. Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns. Chin Med J (Engl) 2016; 128:1922-31. [PMID: 26168834 PMCID: PMC4717919 DOI: 10.4103/0366-6999.160546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCOrapid system can improve well-being of both HDP parturient and their babies. Methods: Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer's solution (LR), parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV) provided via LiDCOrapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results: The severity of HDP was similar between two groups. The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01). There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05), and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group. Conclusions: Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to stable HDP parturient and their babies.
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Affiliation(s)
| | | | | | | | | | | | - Tian-Long Wang
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
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20
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Rimmer S, Roberts SA, Heazell AEP. Cervical dilatation and grade of doctor affects the interval between decision and result of fetal scalp blood sampling in labour. J Matern Fetal Neonatal Med 2015; 29:2671-4. [PMID: 26399279 DOI: 10.3109/14767058.2015.1099157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fetal scalp blood sampling (FSBS) is used to provide information regarding fetal acid-base status during labour. This study assessed the interval between the decision to perform the procedure and obtaining the result and evaluated whether it is affected by cervical dilatation or the experience of the doctor. The median time for FSBS was 10 min. When cervical dilatation was ≤4 cm samples took approximately 30% longer to obtain. After adjustment for dilation, there were no significant differences between different grades of doctors. FSBS is shorter than previously reported; clinicians should be aware that procedures in early labour take longer to complete.
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Affiliation(s)
- Stephanie Rimmer
- a Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester , Manchester , UK .,b St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK , and
| | - Stephen A Roberts
- c Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester , Manchester , UK
| | - Alexander E P Heazell
- a Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester , Manchester , UK .,b St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK , and
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21
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Xiao W, Duan Q, Zhao L, Chi X, Wang F, Ma D, Wang T. Goal-directed fluid therapy may improve hemodynamic stability in parturient women under combined spinal epidural anesthesia for cesarean section and newborn well-being. J Obstet Gynaecol Res 2015; 41:1547-55. [PMID: 26183034 DOI: 10.1111/jog.12769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/23/2015] [Accepted: 05/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Wei Xiao
- Department of Anesthesiology; Capital Medical University; Beijing China
| | - Qingfang Duan
- Department of Anesthesiology; Capital Medical University; Beijing China
| | - Lei Zhao
- Department of Anesthesiology; Capital Medical University; Beijing China
| | - Xinzuo Chi
- Department of Obstetrics and Gynecology, Xuan Wu Hospital; Capital Medical University; Beijing China
| | - Fengying Wang
- Department of Obstetrics and Gynecology, Xuan Wu Hospital; Capital Medical University; Beijing China
| | - Daqing Ma
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London; Chelsea and Westminster Hospital; London UK
| | - Tianlong Wang
- Department of Anesthesiology; Capital Medical University; Beijing China
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Dalili H, Nili F, Sheikh M, Hardani AK, Shariat M, Nayeri F. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. PLoS One 2015; 10:e0122116. [PMID: 25811904 PMCID: PMC4374718 DOI: 10.1371/journal.pone.0122116] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/20/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To compare the Conventional, Specified, Expanded and Combined Apgar scoring systems in predicting birth asphyxia and the adverse early neurologic outcomes. METHODS This prospective cohort study was conducted on 464 admitted neonates. In the delivery room, after delivery the umbilical cord was double clamped and a blood samples was obtained from the umbilical artery for blood gas analysis, meanwhile on the 1- , 5- and 10- minutes Conventional, Specified, Expanded, and Combined Apgar scores were recorded. Then the neonates were followed and intracranial ultrasound imaging was performed, and the following information were recorded: the occurrence of birth asphyxia, hypoxic Ischemic Encephalopathy (HIE), intraventricular hemorrhage (IVH), and neonatal seizure. RESULTS The Combined-Apgar score had the highest sensitivity (97%) and specificity (99%) in predicting birth asphyxia, followed by the Specified-Apgar score that was also highly sensitive (95%) and specific (97%). The Expanded-Apgar score was highly specific (95%) but not sensitive (67%) and the Conventional-Apgar score had the lowest sensitivity (81%) and low specificity (81%) in predicting birth asphyxia. When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of HIE (B = 1.61, P = 0.02) and IVH (B = 2.8, P = 0.01). CONCLUSIONS The newly proposed Combined-Apgar score is highly sensitive and specific in predicting birth asphyxia and also is a good predictor of the occurrence of HIE and IVH in asphyxiated neonates.
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Affiliation(s)
- Hosein Dalili
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firouzeh Nili
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sheikh
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kamal Hardani
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nayeri
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Comparison of the Four Proposed Apgar Scoring Systems in the Assessment of Birth Asphyxia and Adverse Early Neurologic Outcomes. PLoS One 2015. [DOI: 10.1371/journal.pone.0122116
'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wang K, Cao L, Deng Q, Sun LQ, Gu TY, Song J, Qi DY. The effects of epidural/spinal opioids in labour analgesia on neonatal outcomes: a meta-analysis of randomized controlled trials. Can J Anaesth 2014; 61:695-709. [PMID: 25011701 DOI: 10.1007/s12630-014-0185-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 05/15/2014] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Epidural/spinal opioids are increasingly used to relieve parturients' pain in labour. Some studies indicate that opioids can induce side effects in neonates, such as respiratory depression and neurobehavioural changes. This meta-analysis aimed to clarify the effects of opioids in labour analgesia on neonates. SOURCE PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE™ were searched for relevant randomized controlled trials (RCTs). The neonatal data of Apgar scores, Neurological and Adaptive Capacity Scores (NACS), and umbilical cord pH values were extracted. Statistical analyses were carried out using Review Manager 5.2 and Stata(®) 10. PRINCIPAL FINDINGS Twenty-one trials with 2,859 participants were included in our meta-analysis. No difference in the incidence of Apgar scores < 7 was shown between the opioid and control groups at one minute (risk difference [RD] 0.0%, 95% confidence interval [CI]: -3.0 to 2.0, P = 0.78; I (2) = 0%, 95% CI: 0 to 50) and at five minutes (RD -1.0%, 95% CI: -2.0 to 1.0, P = 0.31; I(2) = 0%, 95% CI: 0 to 50). No significant differences were found in the NACS at two hours (mean difference [MD] -0.35, 95% CI: -1.70 to 1.01, P = 0.62; I(2) = 0%, 95% CI: 0 to 79) and at 24 hr (MD -0.45, 95% CI: -1.36 to 0.46, P = 0.33; I(2) = 3%, 95% CI: 0 to 26). Also, no significant differences were found in umbilical cord artery pH (MD -0.02, 95% CI: -0.06 to 0.03, P = 0.48; I(2) = 80%, 95% CI: 46 to 92) and vein pH (MD -0.03, 95% CI: -0.07 to 0.00, P = 0.08; I(2) = 77%, 95% CI: 36 to 91). No significant publication bias was found. CONCLUSION The common doses of fentanyl and sufentanil used with an epidural/spinal technique in labour analgesia are safe for neonates up to 24 hr after delivery. In future studies, more attention should be paid to the long-term side effects in neonates.
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Affiliation(s)
- Kai Wang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical College, Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, 99 West Huaihai Road, Xuzhou, 221006, PR China
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Sadoh WE, Eregie CO, Nwaneri DU, Sadoh AE. The diagnostic value of both troponin T and creatinine kinase isoenzyme (CK-MB) in detecting combined renal and myocardial injuries in asphyxiated infants. PLoS One 2014; 9:e91338. [PMID: 24625749 PMCID: PMC3953387 DOI: 10.1371/journal.pone.0091338] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background Troponin T (cTnT) and Creatinine Kinase Isoenzyme (CK-MB) are both markers of myocardial injuries. However, CK-MB is also elevated in acute kidney injury. Objective The diagnostic value of both cTnT and cardiac CK-MB in combined myocardial and acute kidney injuries (AKI) in asphyxiated neonates was evaluated. Method 40 asphyxiated infants and 40 non-asphyxiated controls were consecutively recruited. Serum levels of cTnT, CK-MB and creatinine were measured. Myocardial injury and AKI were defined as cTnT >95th percentile of the control and serum creatinine >1.0 mg/dl respectively. Results Of the 40 subjects, 9 (22.50%), 8 (20.00%) and 4 (10.00%) had myocardial injury, AKI and combined AKI and myocardial injuries respectively. The mean cTnT and CK-MB values were highest in infants with combined AKI and myocardial injuries. The Mean cTnT in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 0.010±0.0007 ng/ml, 0.067±0.040 ng/ml and 0.084±0.067 ng/ml respectively, p = 0.006. The mean CK-MB in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 2.78±0.22 ng/ml, 1.28±0.11 ng/ml and 4.58±0.52 ng/ml respectively, p = <0.0001. Conclusion In severe perinatal asphyxia, renal and myocardial injuries could co-exist. Elevated cTnT signifies the presence of myocardial injury. Elevated CK-MB indicates either myocardial injury, AKI or both. Therefore renal injury should be excluded in asphyxiated infants with elevated CK-MB.
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Affiliation(s)
- Wilson E. Sadoh
- Department of Child Health, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria
- * E-mail:
| | - Charles O. Eregie
- Institute of Child Health, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria
| | - Damian U. Nwaneri
- Institute of Child Health, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria
| | - Ayebo E. Sadoh
- Institute of Child Health, University of Benin/University of Benin Teaching Hospital, Benin City, Nigeria
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Association between hypoxia and perinatal arterial ischemic stroke: a meta-analysis. PLoS One 2014; 9:e90106. [PMID: 24587227 PMCID: PMC3938587 DOI: 10.1371/journal.pone.0090106] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Perinatal arterial ischemic stroke (AIS) occurs in an estimated 17 to 93 per 100000 live births, yet the etiology is poorly understood. Although investigators have implicated hypoxia as a potential cause of AIS, the role of hypoxia in AIS remains controversial. The aim of this study was to estimate the association between perinatal hypoxia factors and perinatal arterial ischemic stroke through a meta-analysis of published observational studies. PATIENTS AND METHODS A systematic search of electronically available studies published through July 2013 was conducted. Publication bias and heterogeneity across studies were evaluated and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with fixed-effects or random-effects models. RESULTS A total of 8 studies describing the association between perinatal hypoxia factors and neonatal arterial ischemic stroke (AIS) met inclusion criteria, and 550 newborns with AIS were enrolled. The associations were found for AIS: preeclampsia (OR 2.14; 95% CI, 1.25 to 3.66), ventouse delivery (OR 2.23; 95% CI, 1.26 to 3.97), fetal heart rate abnormalities (OR 6.30; 95% CI, 3.84 to 10.34), reduced fetal movement (OR 5.35; 95% CI, 2.17 to 13.23), meconium-stained liquor (OR 3.05; 95% CI, 2.02 to 4.60), low Apgar score (OR 5.77; 95% CI, 1.66 to 20.04) and resuscitation at birth (OR 4.59; 95% CI, 3.23 to 6.52). Our data did not show any significant change of the mean risk estimate for oxytocin induction (OR 1.33; 95% CI, 0.84 to 2.11) and low arterial umbilical cord ph (OR 4.63; 95% CI 2.14 to 9.98). CONCLUSIONS There is a significant association between perinatal hypoxia factors and AIS. The result indicates that perinatal hypoxia maybe one of causes of AIS. Large scale prospective clinical studies are still warranted.
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Abstract
Very small changes in pH may significantly affect the function of various fetal organ systems, such as the central nervous system, and the cardiovascular system with associated fetal distress and poor Apgar score. Review of existing data on maternal-fetal acid-base balance in pregnancy highlight the factors that are associated with derangements of the acid-base status and the impact of the derangements on fetal outcome. Extensive search of electronic databases and manual search of journals for relevant literature on maternal and fetal acid chemistry, clinical studies and case studies were undertaken. There is a substantial reduction in the partial pressure of carbon dioxide (pCO2) in pregnancy. Adequate buffering prevents significant changes in maternal arterial pH. Normal fetal metabolism results in the production of acids which are buffered to maintain extracellular pH within a critical range. Fetal hypoxia can occur when maternal oxygenation is compromised, maternal perfusion of the placenta is reduced, or delivery of oxygenated blood from the placenta to the fetus is impeded. When adequate fetal oxygenation does not occur, metabolisms proceed along with an anaerobic pathway with production of organic acids, such as lactic acid. Accumulation of lactic acid can deplete the buffer system and result in metabolic acidosis with associated low fetal pH, fetal distress and poor Apgar score. There is a significant reduction in pCO2 in pregnancy. This change, however, does not result in a corresponding significant reduction in maternal arterial pH, because of adequate buffering. Very small changes in pH may cause significant derangement in fetal function and outcome.
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Affiliation(s)
- L Omo-Aghoja
- Department of Obstetrics & Gynecology, Faculty of Clinical Medicine, Delta State University, Abraka, Nigeria
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Keihani-Doust Z, Saeedi M, Esmaeilni T, Habibi M, Nazari SSH. Two-year follow-up study on neurodevelopmental outcomes after term intrapartum asphyxia using age and stages questionnaire. J Child Neurol 2013; 28:1555-61. [PMID: 23112249 DOI: 10.1177/0883073812461564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Birth asphyxia is one of the multiple causes of neonatal encephalopathy. The objective of this study was to evaluate neurodevelopmental outcomes of newborn term infants with definitive asphyxia. Thirty infants met study criteria for asphyxia. The 5-year incidence of asphyxia was estimated to be 5.5 in 1000. According to the Age and Stage Questionnaire, 10.5% of 6-month-old infants, 14.3% of 12- and 18-month-old infants, and 5.3% of 24-month-old infants had neurodevelopmental delay in gross motor function in the absence of cerebral palsy. In 7.3% of 18-month-old infants, neurodevelopmental delay in problem-solving ability was observed. Higher values of Apgar score and bicarbonate levels were associated with higher Age and Stage Questionnaire total score. Delivery type, maternal age, gravidity of mother, and existence of mother disease during pregnancy were also associated with lower Age and Stage Questionnaire total score in different stages of life.
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Affiliation(s)
- Zarrin Keihani-Doust
- 1Department of Pediatrics, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kayani SI, Joo Tan M, Shaw NJ, Dewhurst C, Titman A, Lancaster G, Alfirevic Z. Two-year outcomes for infants with low cord pH at birth. J Matern Fetal Neonatal Med 2013; 27:1010-4. [PMID: 24090442 DOI: 10.3109/14767058.2013.847915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the long-term outcome of infants born with cord pH ≤ 7.0 and no clinical evidence of asphyxia at birth. DESIGN SETTING Tertiary Referral Centre. A prospective matched cohort study was conducted. 51 term infants were recruited following singleton birth with venous cord pH ≤ 7.0. For each recruited baby a healthy baby with normal cord pH ≥ 7.20 was recruited matched for gestation, gender and mode of delivery. Ages and Stages Questionnaires (ASQ)(TM) and Health Screening Questionnaires (HSQ) were sent out at 24 months of age. Two independent assessors, blinded to the case assignment, reviewed intrapartum and neonatal events to look for clinical evidence of birth asphyxia among the cases. RESULT From 102 infants recruited, 62 questionnaires (24 cases, 38 controls) were returned. 20 matched pairs with no clinical evidence of birth asphyxia were available for analysis. The groups were similar except in terms of birth weight; the pH ≥ 7.0 group had mean birth weight 584 g lower than controls (p = 0.005). The ASQ motor scores were lower in children born with low cord pH (p = 0.019); however, once adjusted for birth weight, the difference was not significant (p = 0.289). CONCLUSION It is unlikely that abnormal cord pH in otherwise healthy neonates leads to a substantially increased risk of abnormal neurodevelopmental outcome or severe health problems by 2 years of age.
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Affiliation(s)
- Salma I Kayani
- Department of Gynaecology, BMI The Somerfield Hospital , Maidstone, Kent , UK
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Uslu S, Bulbul A, Can E, Zubarioglu U, Salihoglu O, Nuhoglu A. Relationship between oxygen saturation and umbilical cord pH immediately after birth. Pediatr Neonatol 2012; 53:340-5. [PMID: 23276437 DOI: 10.1016/j.pedneo.2012.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 03/01/2012] [Accepted: 03/15/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study is to determine the relationship between oxygen saturation (SpO(2)) by pulse oximetry levels and umbilical cord arterial pH values in healthy newborns during the first 15 minutes of life. METHODS The study was performed with healthy term, appropriate-for-gestational-age newborn infants. The infants were divided in two groups: umbilical cord arterial blood pH value ≤7.19 (group 1) and >7.19 (group 2); SpO(2) levels during the first 15 minutes of life were compared between groups. RESULTS The study was completed with 129 infants (33 in group 1 and 96 in group 2). A significant correlation was found between first-measured preductal and postductal SpO(2) levels by pulse oximetry and umbilical cord arterial pH values ([r²:0.72(0.62 -0.79); p < 0.001] and [r²:0.32(0.25 - 0.54); p < 0.001], respectively). In group 1, infants had lower SpO(2) levels at both preductal and postductal measurements during the first 11 minutes of life and time to reach ≥90% SpO(2) level was longer compared with infants in group 2. CONCLUSION Determination of umbilical arterial blood pH values, in addition to clinical findings and oxygen saturation measurements, might be helpful in deciding the concentration of oxygen and whether or not to continue oxygen supplementation in the delivery room.
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Affiliation(s)
- Sinan Uslu
- Department of Pediatrics, Division of Neonatology, Sisli Etfal Children Hospital, Istanbul, Turkey.
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Everaert N, Willemsen H, Willems E, Franssens L, Decuypere E. Acid–base regulation during embryonic development in amniotes, with particular reference to birds. Respir Physiol Neurobiol 2011; 178:118-28. [DOI: 10.1016/j.resp.2011.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/27/2011] [Accepted: 04/28/2011] [Indexed: 11/28/2022]
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Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ 2010; 340:c1471. [PMID: 20466789 PMCID: PMC2869402 DOI: 10.1136/bmj.c1471] [Citation(s) in RCA: 282] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the association between umbilical cord pH at birth and long term outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline (1966-August 2008), Embase (1980-August 2008), the Cochrane Library (2008 issue 8), and Medion, without language restrictions; reference lists of selected articles; and contact with authors. STUDY SELECTION Studies in which cord pH at birth was compared with any neonatal or long term outcome. Cohort and case-control designs were included. RESULTS 51 articles totalling 481 753 infants met the selection criteria. Studies varied in design, quality, outcome definition, and results. Meta-analysis carried out within predefined groups showed that low arterial cord pH was significantly associated with neonatal mortality (odds ratio 16.9, 95% confidence interval 9.7 to 29.5, I(2)=0%), hypoxic ischaemic encephalopathy (13.8, 6.6 to 28.9, I(2)=0%), intraventricular haemorrhage or periventricular leucomalacia (2.9, 2.1 to 4.1, I(2)=0%), and cerebral palsy (2.3, 1.3 to 4.2, I(2)=0%). CONCLUSIONS Low arterial cord pH showed strong, consistent, and temporal associations with clinically important neonatal outcomes that are biologically plausible. These data can be used to inform clinical management and justify the use of arterial cord pH as an important outcome measure alongside neonatal morbidity and mortality in obstetric trials.
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Affiliation(s)
- Gemma L Malin
- Department of Obstetrics, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham.
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Malin GL, Morris RK, Khan KS. Mary Crosse project: systematic reviews and grading the value of neonatal tests in predicting long term outcomes. BMC Pregnancy Childbirth 2009; 9:49. [PMID: 19874579 PMCID: PMC2774285 DOI: 10.1186/1471-2393-9-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 10/29/2009] [Indexed: 11/23/2022] Open
Abstract
Background Events before birth, condition at birth, events immediately following birth, and condition in early childhood are linked together, and have implications for health and disease in adulthood. At present, there is lack of clarity about the tests that purport to link these various stages. This is partly because there is paucity of collated information about the best strategies for predicting longer-term outcomes before (using tests in fetal period) or after birth (using tests in neonatal period, infancy as well as early childhood). Methods/Design A series of systematic reviews and meta-analyses will be undertaken to determine, amongst neonates, the ability of various tests and measures to predict infant, childhood and adult outcomes. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate), exploration of heterogeneity and publication bias. Evidence collated will be graded for its quality to support decision making. Discussion The project will collate, synthesise and evaluate the available evidence concerning the value of tests of neonatal wellbeing to predict long term outcomes. The systematic reviews will assess the quality of available evidence and identify tests with the strongest association with outcomes, and assess their economic value. The output of this project will help formulate practice recommendations.
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Affiliation(s)
- Gemma L Malin
- Academic Department of Obstetrics and Gynaecology, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital, Birmingham, UK.
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Irland NB. Late decelerations and acid-base balance: metabolic acidosis explained in story form. Nurs Womens Health 2009; 13:335-340. [PMID: 19686557 DOI: 10.1111/j.1751-486x.2009.01444.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Buchmann EJ, Velaphi SC. Confidential enquiries into hypoxic ischaemic encephalopathy. Best Pract Res Clin Obstet Gynaecol 2009; 23:357-68. [DOI: 10.1016/j.bpobgyn.2008.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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