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Noble RMN, Kirschenman R, Wiedemeyer A, Patel V, Rachid JJ, Zemp RJ, Davidge ST, Bourque SL. Use of Photoacoustic Imaging to Study the Effects of Anemia on Placental Oxygen Saturation in Normoxic and Hypoxic Conditions. Reprod Sci 2024; 31:966-974. [PMID: 38012522 DOI: 10.1007/s43032-023-01395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
We aimed to evaluate fetal and placental oxygen saturation (sO2) in anemic and non-anemic pregnant rats throughout gestation using photoacoustic imaging (PAI). Female Sprague-Dawley rats were fed an iron-restricted or iron-replete diet before and during pregnancy. On gestational days 13, 18, and 21, PAI was coupled with high resolution ultrasound to measure oxygenation of the fetus, whole placenta, mesometrial triangle, as well as the maternal and fetal faces of the placenta. PAI was performed in 3D, which allowed sO2 to be measured within an entire region, as well as in 2D, which enabled sO2 measurements in response to a hypoxic event in real time. Both 3D and 2D PAI were performed at varying levels of FiO2 (fraction of inspired oxygen). Iron restriction caused anemia in dams and fetuses, a reduction in fetal body weight, and an increase in placental weight, but overall had minimal effects on sO2. Reductions in FiO2 caused corresponding reductions in sO2 which correlated to the severity of the hypoxic challenge. Regional differences in sO2 were evident within the placenta and between the placenta and fetus. In conclusion, PAI enables non-invasive measurement of sO2 both rapidly and with a high degree of sensitivity. The lack of overt changes in sO2 levels between control and anemic fetuses may suggest reduced oxygen extraction and utilization in the latter group, which could be attributed to compensatory changes in growth and developmental trajectories.
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Affiliation(s)
- Ronan M N Noble
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
- Cardiovascular Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Raven Kirschenman
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - Alyssa Wiedemeyer
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
- Cardiovascular Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Vaishvi Patel
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Jad-Julian Rachid
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
- Cardiovascular Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Roger J Zemp
- Cardiovascular Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Sandra T Davidge
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
- Cardiovascular Research Institute, University of Alberta, Edmonton, AB, Canada
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
| | - Stephane L Bourque
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
- Cardiovascular Research Institute, University of Alberta, Edmonton, AB, Canada.
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- Department of Physiology, University of Alberta, Edmonton, AB, Canada.
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada.
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Blix E, Brurberg KG, Reierth E, Reinar LM, Øian P. ST waveform analysis vs cardiotocography alone for intrapartum fetal monitoring: An updated systematic review and meta-analysis of randomized trials. Acta Obstet Gynecol Scand 2024; 103:437-448. [PMID: 38093630 PMCID: PMC10867373 DOI: 10.1111/aogs.14752] [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: 09/25/2023] [Revised: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION ST waveform analysis (STAN) was introduced as an adjunct to cardiotocography (CTG) to improve neonatal and maternal outcomes. The aim of the present study was to quantify the efficacy of STAN vs CTG and assess the quality of the evidence using GRADE. MATERIAL AND METHODS We performed systematic literature searches to identify randomized controlled trials and assessed included studies for risk of bias. We performed meta-analyses, calculating pooled risk ratio (RR) or Peto odds ratio (OR). We also performed post hoc trial sequential analyses for selected outcomes to assess the risk of false-positive results and the need for additional studies. RESULTS Nine randomized controlled trials including 28 729 women were included in the meta-analysis. There were no differences between the groups in operative deliveries for fetal distress (10.9 vs 11.1%; RR 0.96; 95% confidence interval [CI] 0.82-1.11). STAN was associated with a significantly lower rate of metabolic acidosis (0.45% vs 0.68%; Peto OR 0.66; 95% CI 0.48-0.90). Accordingly, 441 women need to be monitored with STAN instead of CTG alone to prevent one case of metabolic acidosis. Women allocated to STAN had a reduced risk of fetal blood sampling compared with women allocated to conventional CTG monitoring (12.5% vs 19.6%; RR 0.62; 95% CI 0.49-0.80). The quality of the evidence was high to moderate. CONCLUSIONS Absolute effects of STAN were minor and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is insufficient evidence to state that STAN as an adjunct to CTG leads to important clinical benefits compared with CTG alone.
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Affiliation(s)
- Ellen Blix
- Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Kjetil Gundro Brurberg
- The Norwegian Institute of Public HealthOsloNorway
- Center for Evidence Based PracticeWestern Norway University of Applied SciencesBergenNorway
| | - Eirik Reierth
- Science and Health LibraryUniversity Library, UiT The Arctic University of NorwayTromsøNorway
| | | | - Pål Øian
- Department of Obstetrics and GynecologyUniversity Hospital of North NorwayTromsøNorway
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Lia M, Martin M, Költzsch E, Stepan H, Dathan-Stumpf A. Mechanics of vaginal breech birth: Factors influencing obstetric maneuver rate, duration of active second stage of labor, and neonatal outcome. Birth 2023. [PMID: 38115221 DOI: 10.1111/birt.12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/16/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND We investigated possible parameters that could predict the need for obstetric maneuvers, the duration of the active second stage of labor (i.e., the duration of active pushing), and short-term neonatal outcome in vaginal breech births. MATERIALS AND METHODS We performed a retrospective analysis of 268 successful singleton vaginal breech births in women without previous vaginal births from January 2015 to August 2022. Multivariable regression was used to investigate associations between maternal and fetal characteristics (including antepartum magnetic resonance (MR) pelvimetry) with obstetric maneuvers, the duration of active second stage of labor, pH values, and admission to the neonatal unit. Models for the prediction of obstetric maneuvers were built and internally validated. RESULTS Obstetric maneuvers were performed in a total of 130 women (48.5%). A total of 32 neonates (11.9%) had to be admitted to the neonatal unit. The intertuberous distance (ITD) (p < 0.001), epidural analgesia (p < 0.001), and birthweight (p = 0.026) were associated with the duration of active second stage of labor. ITD (p = 0.028) and birthweight (p = 0.011) were also independently associated with admission to the neonatal unit, while pH values below 7.10 dropped significantly (p = 0.0034) if ITD was ≥13 cm. Furthermore, ITD (p < 0.001) and biparietal diameter (p = 0.002) were independent predictors for obstetric maneuvers. CONCLUSIONS ITD is independently associated with the duration of active second stage of labor. Thus, it can predict suboptimal birth mechanics in the last stage of birth, which may lead to the need for obstetric maneuvers, lower arterial pH values, and admission to the neonatal unit. Consequently, MR pelvimetry gives additional information for practitioners and birthing people preferring a vaginal breech birth.
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Affiliation(s)
- Massimiliano Lia
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
| | - Mireille Martin
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Költzsch
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
| | - Anne Dathan-Stumpf
- Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
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Kovo M, Berman E, Odeh H, Luria O, Beloosesky R, Bar J. The effects of inflammation and acidosis on placental blood vessels reactivity. Placenta 2023; 144:8-12. [PMID: 37949032 DOI: 10.1016/j.placenta.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/04/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Inflammation and acidosis are two stress stimuli that correspond to pathophysiological processes occurring in placental-mediated vascular disorders. We aimed to investigate the effects of these stimuli on placental chorionic blood vessels reactivity using the ex-vivo placental perfusion model. METHODS Term placentas were obtained immediately after cesarean deliveries, and selected cotyledons were cannulated and dually perfused ex-vivo. Placentas were perfused with three different protocols: culture medium (M199-controls, n = 5), culture medium with lipopolysaccharide (inflammatory stimuli) (LPS,1 μg/ml, n = 7), and acidotic culture medium (M - 199, pH: 6.9-7, n = 6). Each perfusion experiment was maintained for 180 min. Fetal perfusion pressure was continuously measured. Measurements in response to angiotensin II (AT II) at the end of the perfusion were compared between the treatment groups, including amplitude of the contraction response, relaxation factor, time to maximal constriction and the area under the pressure curve (AUC). RESULTS In response to ATII there was a significant difference in the amplitude of the contraction and the AUC between the treatment groups, (p = 0.049, p = 0.015, respectively). As compared with control perfused cotyledon, the inflammatory stimuli significantly increased the vasoconstriction response to ATII in fetal placental blood vessels, as expressed by increased AUC - median (IQR): 555 (235-1184) vs. 133 (118-207), respectively, p = 0.017. The time to maximal constriction and the relaxation factor did not differ between the groups. DISCUSSION Inflammatory stimuli but not acidosis impact fetal-placental vasculature in response to ATII, suggesting that inflammation can compromise vascular function.
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Affiliation(s)
- Michal Kovo
- Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
| | - Erez Berman
- Wolfson Medical Center, Holon, Israel; Institute for Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Israel
| | - Hind Odeh
- Wolfson Medical Center, Holon, Israel
| | - Oded Luria
- Faculty of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel
| | | | - Jacob Bar
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Wolfson Medical Center, Holon, Israel
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Myrhaug HT, Kaasen A, Pay ASD, Henriksen L, Smedslund G, Saugstad OD, Blix E. Umbilical cord blood acid-base analysis at birth and long-term neurodevelopmental outcomes in children: a systematic review and meta-analysis. BJOG 2023. [PMID: 37041099 DOI: 10.1111/1471-0528.17480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Umbilical cord blood acid-base sampling is routinely performed at many hospitals. Recent studies have questioned this practice and the association of acidosis with cerebral palsy. OBJECTIVE To investigate the associations between the results of umbilical cord blood acid-base analysis at birth and long-term neurodevelopmental outcomes and mortality in children. SEARCH STRATEGY We searched six databases using the search strategy: umbilical cord AND outcomes. SELECTION CRITERIA Randomised controlled trials, cohorts and case-control studies from high-income countries that investigated the association between umbilical cord blood analysis and neurodevelopmental outcomes and mortality from 1 year after birth in children born at term. DATA COLLECTION AND ANALYSIS We critically assessed the included studies, extracted data and conducted meta-analyses comparing adverse outcomes between children with and without acidosis, and the mean proportions of adverse outcomes. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. MAIN RESULTS We have very low confidence in the following findings: acidosis was associated with higher cognitive development scores compared with non-acidosis (mean difference 5.18, 95% CI 0.84-9.52; n = two studies). Children with acidosis also showed a tendency towards higher risk of death (relative risk [RR] 5.72, 95% CI 0.90-36.27; n = four studies) and CP (RR 3.40, 95% CI 0.86-13.39; n = four studies), although this was not statistically significant. The proportion of children with CP was 2.39/1000 across the studies, assessed as high certainty evidence. CONCLUSION Due to low certainty of evidence, the associations between umbilical cord blood gas analysis at delivery and long-term neurodevelopmental outcomes in children remains unclear.
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Affiliation(s)
- H T Myrhaug
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - A Kaasen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - A S D Pay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - L Henriksen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - G Smedslund
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - O D Saugstad
- Department of Paediatric Research, University of Oslo, Nydalen, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - E Blix
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Olofsson P. Umbilical cord pH, blood gases, and lactate at birth: normal values, interpretation, and clinical utility. Am J Obstet Gynecol 2023; 228:S1222-S1240. [PMID: 37164495 DOI: 10.1016/j.ajog.2022.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 03/21/2023]
Abstract
Normal birth is a eustress reaction, a beneficial hedonic stress with extremely high catecholamines that protects us from intrauterine hypoxia and assists in the rapid shift to extrauterine life. Occasionally the cellular O2 requirement becomes critical and an O2 deficit in blood (hypoxemia) may evolve to a tissue deficit (hypoxia) and finally a risk of organ damage (asphyxia). An increase in H+ concentration is reflected in a decrease in pH, which together with increased base deficit is a proxy for the level of fetal O2 deficit. Base deficit (or its negative value, base excess) was introduced to reflect the metabolic component of a low pH and to distinguish from the respiratory cause of a low pH, which is a high CO2 concentration. Base deficit is a theoretical estimate and not a measured parameter, calculated by the blood gas analyzer from values of pH, the partial pressure of CO2, and hemoglobin. Different brands of analyzers use different calculation equations, and base deficit values can thus differ by multiples. This could influence the diagnosis of metabolic acidosis, which is commonly defined as a pH <7.00 combined with a base deficit ≥12.0 mmol/L in umbilical cord arterial blood. Base deficit can be calculated as base deficit in blood (or actual base deficit) or base deficit in extracellular fluid (or standard base deficit). The extracellular fluid compartment represents the blood volume diluted with the interstitial fluid. Base deficit in extracellular fluid is advocated for fetal blood because a high partial pressure of CO2 (hypercapnia) is common in newborns without concomitant hypoxia, and hypercapnia has a strong influence on the pH value, then termed respiratory acidosis. An increase in partial pressure of CO2 causes less increase in base deficit in extracellular fluid than in base deficit in blood, thus base deficit in extracellular fluid better represents the metabolic component of acidosis. The different types of base deficit for defining metabolic acidosis in cord blood have unfortunately not been noticed by many obstetrical experts and organizations. In addition to an increase in H+ concentration, the lactate production is accelerated during hypoxia and anaerobic metabolism. There is no global consensus on definitions of normal cord blood gases and lactate, and different cutoff values for abnormality are used. At a pH <7.20, 7% to 9% of newborns are deemed academic; at <7.10, 1% to 3%; and at <7.00, 0.26% to 1.3%. From numerous studies of different eras and sizes, it can firmly be concluded that in the cord artery, the statistically defined lower pH limit (mean -2 standard deviations) is 7.10. Given that the pH for optimal enzyme activity differs between different cell types and organs, it seems difficult to establish a general biologically critical pH limit. The blood gases and lactate in cord blood change with the progression of pregnancy toward a mixed metabolic and respiratory acidemia because of increased metabolism and CO2 production in the growing fetus. Gestational age-adjusted normal reference values have accordingly been published for pH and lactate, and they associate with Apgar score slightly better than stationary cutoffs, but they are not widely used in clinical practice. On the basis of good-quality data, it is reasonable to set a cord artery lactate cutoff (mean +2 standard deviations) at 10 mmol/L at 39 to 40 weeks' gestation. For base deficit, it is not possible to establish statistically defined reference values because base deficit is calculated with different equations, and there is no consensus on which to use. Arterial cord blood represents the fetus better than venous blood, and samples from both vessels are needed to validate the arterial origin. A venoarterial pH gradient of <0.02 is commonly used to differentiate arterial from venous samples. Reference values for pH in cord venous blood have been determined, but venous blood comes from the placenta after clearance of a surplus of arterial CO2, and base deficit in venous blood then overestimates the metabolic component of fetal acidosis. The ambition to increase neonatal hemoglobin and iron depots by delaying cord clamping after birth results in falsely acidic blood gas and lactate values if the blood sampling is also delayed. Within seconds after birth, sour metabolites accumulated in peripheral tissues and organs will flood into the central circulation and further to the cord arteries when the newborn starts to breathe, move, and cry. This influence of "hidden acidosis" can be avoided by needle puncture of unclamped cord vessels and blood collection immediately after birth. Because of a continuing anaerobic glycolysis in the collected blood, it should be analyzed within 5 minutes to not result in a falsely high lactate value. If the syringe is placed in ice slurry, the time limit is 20 minutes. For pH, it is reasonable to wait no longer than 15 minutes if not in ice. Routine analyses of cord blood gases enable perinatal audits to gain the wisdom of hindsight, to maintain quality assurance at a maternity unit over years by following the rate of neonatal acidosis, to compare results between hospitals on regional or national bases, and to obtain an objective outcome measure in clinical research. Given that the intrapartum cardiotocogram is an uncertain proxy for fetal hypoxia, and there is no strong correlation between pathologic cardiotocograms and fetal acidosis, a cord artery pH may help rather than hurt a staff person subjected to a malpractice suit based on undesirable cardiotocogram patterns. Contrary to common beliefs and assumptions, up to 90% of cases of cerebral palsy do not originate from intrapartum events. Future research will elucidate whether cell injury markers with point-of-care analysis will become valuable in improving the dating of perinatal injuries and differentiating hypoxic from nonhypoxic injuries.
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Affiliation(s)
- Per Olofsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
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7
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Ghesquière L, Perbet R, Lacan L, Hamoud Y, Stichelbout M, Sharma D, Nguyen S, Storme L, Houfflin-Debarge V, De Jonckheere J, Garabedian C. Associations between fetal heart rate variability and umbilical cord occlusions-induced neural injury: An experimental study in a fetal sheep model. Acta Obstet Gynecol Scand 2022; 101:758-770. [PMID: 35502642 DOI: 10.1111/aogs.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study evaluated the association between fetal heart rate variability (HRV) and the occurrence of hypoxic-ischemic encephalopathy in a fetal sheep model. MATERIAL AND METHODS The experimental protocol created a hypoxic condition with repeated cord occlusions in three phases (A, B, C) to achieve acidosis to pH <7.00. Hemodynamic, gasometric and HRV parameters were analyzed during the protocol, and the fetal brain, brainstem and spinal cord were assessed histopathologically 48 h later. Associations between the various parameters and neural injury were compared between phases A, B and C using Spearman's rho test. RESULTS Acute anoxic-ischemic brain lesions in all regions was present in 7/9 fetuses, and specific neural injury was observed in 3/9 fetuses. The number of brainstem lesions correlated significantly and inversely with the HRV fetal stress index (r = -0.784; p = 0.021) in phase C and with HRV long-term variability (r = -0.677; p = 0.045) and short-term variability (r = -0.837; p = 0.005) in phase B. The number of neurological lesions did not correlate significantly with other markers of HRV. CONCLUSIONS Neural injury caused by severe hypoxia was associated with HRV changes; in particular, brainstem damage was associated with changes in fetal-specific HRV markers.
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Affiliation(s)
- Louise Ghesquière
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Romain Perbet
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laure Lacan
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Yasmine Hamoud
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Morgane Stichelbout
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Dyuti Sharma
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Pediatric Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sylvie Nguyen
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Storme
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neonatology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Véronique Houfflin-Debarge
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Julien De Jonckheere
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Clinical Investigation Center - Technological Innovation (CIC-IT 1403), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Charles Garabedian
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
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8
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Ghesquière L, Ternynck C, Sharma D, Hamoud Y, Vanspranghels R, Storme L, Houfflin-Debarge V, De Jonckheere J, Garabedian C. Heart rate markers for prediction of fetal acidosis in an experimental study on fetal sheep. Sci Rep 2022; 12:10615. [PMID: 35739219 PMCID: PMC9226053 DOI: 10.1038/s41598-022-14727-4] [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: 12/10/2021] [Accepted: 06/10/2022] [Indexed: 11/09/2022] Open
Abstract
To overcome the difficulties in interpreting fetal heart rate (FHR), several tools based on the autonomic nervous system and heart rate variability (HRV) have been developed. The objective of this study was to use FHR and HRV parameters for the prediction of fetal hypoxia. It was an experimental study in the instrumented fetal sheep. Repeated umbilical cord occlusions were performed to achieve severe acidosis. Hemodynamic parameters, ECG, and blood gases were analyzed. The variables used were heart rate baseline, HRV analysis (RMSSD, SDNN, LF, HF, HFnu, Fetal Stress Index (FSI), …), and morphological analysis of decelerations. The gold standard used to classify hypoxia was the fetal arterial pH (pH < 7.10). Different multivariable statistical methods (logistic regression and decision trees) were applied for the detection of acidosis. 21 lambs were instrumented. A total of 130 pairs of FHR/fetal pH analysis were obtained of which 29 in the acidosis group and 101 in the non-acidosis group. After logistic regression model with bootstrap resampling and stepwise backward selection, only one variable was selected, FSI. The AUC of FSI alone in this model was 0.81 with a sensitivity of 0.66, specificity of 0.88, PPV of 0.61, and NPV of 0.90 considering a threshold of 68. Decision trees with CHAID and CART algorithms showed a sensitivity of 0.48 and 0.59, respectively, and a specificity of 0.94 for both. All employed methods identified HRV variables as the most predictive of acidosis. The primary variables selected automatically were those from the HRV. Supporting the use of FHRV measures for the screening of fetal acidosis during labour is interesting.
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Affiliation(s)
- Louise Ghesquière
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France. .,Department of Obstetrics, CHU Lille, 59000, Lille, France. .,Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cedex, France.
| | - C Ternynck
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Biostatistics, CHU Lille, 59000, Lille, France
| | - D Sharma
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Pediatric Surgery, CHU Lille, 59000, Lille, France
| | - Y Hamoud
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - R Vanspranghels
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - L Storme
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Neonatology, CHU Lille, 59000, Lille, France
| | - V Houfflin-Debarge
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - J De Jonckheere
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,CHU Lille, CIC-IT 1403, 59000, Lille, France
| | - C Garabedian
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
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Affiliation(s)
| | - Kenneth C Johnson
- School of Epidemiology and Public Health, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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10
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Iorizzo L, Carlsson Y, Johansson C, Berggren R, Herbst A, Wang M, Leiding M, Isberg PE, Kristensen K, Wiberg-Itzel E, McGee T, Wiberg N. Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study. BJOG 2021; 129:636-646. [PMID: 34555249 DOI: 10.1111/1471-0528.16924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/l indicating fetal acidosis is exclusive for the point-of-care device (POC) LactatePro™, which is no longer in production. The aim of this study was to establish a new cutoff for scalp lactate based on neonatal outcomes with the use of the StatstripLactate® /StatstripXpress® Lactate system, the only POC designed for hospital use. DESIGN Observational study. SETTING January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. POPULATION Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks of gestation. METHOD Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. MAIN OUTCOME MEASURES Metabolic acidosis in cord blood defined as pH <7.05 plus BDecf >10 mmol/l and/or lactate >10 mmol/l. RESULTS A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. The areas under the receiver operating characteristics curves (AUC) and corresponding optimal cutoff values were as follows; metabolic acidosis AUC 0.87 (95% CI 0.77-0.97), cutoff 5.7 mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68-0.97), cutoff 4.6 mmol/l; pH <7.05 plus BDecf ≥12 mmol/l AUC 0.97 (95% CI 0.92-1), cutoff 5.8 mmol/l; Apgar score <7 at 5 minutes AUC 0.74 (95% CI 0.63-0.86), cutoff 5.2 mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67-0.85), cutoff 4.8 mmol/l. CONCLUSION A scalp lactate level <5.2 mmol/l using the StatstripLactate® /StatstripXpress® system will safely rule out fetal metabolic acidosis. TWEETABLE ABSTRACT Scalp blood lactate <5.2 mmol/l using the StatstripLactate® /StatstripXpress system has an excellent ability to rule out fetal acidosis.
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Affiliation(s)
- L Iorizzo
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden
| | - Y Carlsson
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - C Johansson
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden
| | - R Berggren
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Herbst
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - M Wang
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - M Leiding
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - P-E Isberg
- Department of Statistics, Lund University, Lund, Sweden
| | - K Kristensen
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - E Wiberg-Itzel
- Department of Obstetrics and Gynaecology, Söder Hospital, Stockholm, Sweden.,Institute of Karolinska, Stockholm, Sweden
| | - T McGee
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - N Wiberg
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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11
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Dain C, Roze JC, Olivier M, Bossard M, Praud M, Flamant C. Neurodevelopmental outcome at 24 months of healthy infants at birth with an umbilical artery blood pH ≤ 7 and/or hyperlactacidemia ≥ 7 mmol/L. Birth 2021; 48:178-185. [PMID: 33511681 DOI: 10.1111/birt.12527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/28/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The incidence of acidosis in term and healthy newborns and the consequences for their neurodevelopment are poorly understood. The aim of our study was to assess neurodevelopmental outcomes at 24 months of age via a parental questionnaire (ASQ, Ages and Stages Questionnaires) for a sample of infants born at term with an umbilical arterial blood pH ≤ 7 or/and hyperlactacidemia ≥ 7 mmol/L. In addition, we compared these groups' neurodevelopmental outcomes with a control group. METHODS During the 29 months of the study, we retrospectively included all children who had an umbilical artery (UA) cord blood pH ≤ 7 and/or lactates ≥ 7 mmol/L with good clinical adaptation. We also included a control group of term newborns with normal gases at birth. Ages and Stages questionnaires were sent to parents at 24 months of age. RESULTS Among the 9016 births during the study, 7.1% of babies had a UA pH ≤ 7 and/or lactates ≥ 7 mmol/L. The ASQ was considered non-optimal for 32.2% and 36.3% of respondents in the acidosis and control group, respectively, without any significant difference (P = 0.382). After matching for gestational age and sex, there was also no significant difference in the rate of non-optimal ASQ. The percentage of abnormal communication was significantly higher in the control group (19.7% vs 11.4%, P = 0.015). CONCLUSIONS Isolated biochemical umbilical cord blood abnormalities in term or near-term newborns with good adaptation do not appear to have a long-term impact on development. These results are rather reassuring, and the absence of specific follow-up for these children seems reasonable.
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Affiliation(s)
- Clémence Dain
- Department of Neonatal Medicine, Departmental Hospital Centre of Vendee, La Roche sur Yon, France
| | | | - Marion Olivier
- Loire Infant Follow-up Team" (LIFT) Network, Pays De Loire, France
| | - Margot Bossard
- Maternity Hospital, Cholet Hospital Center, Cholet, France
| | | | - Cyril Flamant
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
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12
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Schmidt S, Misselwitz B, Schuster R, Schrod L. [Critical Outcome and Hypoxic Ischemic Encephalopathy - A quality Assurance Issue]. Z Geburtshilfe Neonatol 2020; 224:360-366. [PMID: 33027822 DOI: 10.1055/a-1258-4639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study evaluates the predictive value of the critical status of a newborn as to the risk of developing hypoxic ischemic encephalopathy (HIE). METHODS On the basis of the data set from the perinatal survey in Hesse, Germany, in the year 2016, including 52,122 live births (singleton, 37+0 GA), cases of critical newborns were identified. A conjoined analysis with the data set of the neonatal survey from the identical period provided the basis to evaluate the relationship to cases compromised by HIE. RESULTS The incidence of cases with a critical outcome (n=11) and those with HIE (n=29) was low. The sensitivity of the status of the newborn for detecting a risk of HIE was 10.34%. The specificity was 99.98%. The positive predictive value was 27.35%. The negative predictive value was 99.95%. The detailed, confidential single-case analysis indicated the ability to avoid negative outcomes in about one third of cases with a critical status of the newborn (4/11) and HIE (9/29). DISCUSSION AND CONCLUSION The likelihood of developing encephalopathy (HIE) increases after a critical outcome after birth. Intensified monitoring of these newborns is justified. A single-case analysis identifies the potential ways to improve perinatal outcomes. Measures of external quality assurance should integrate the analysis of both perinatal and neonatal surveys as a basis for quality management (QM).
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Affiliation(s)
| | | | | | - Lothar Schrod
- Klinik für Kinder- und Jugendmedizin, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main
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13
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Vanspranghels R, Houfflin-Debarge V, Deken V, Rakza T, Maboudou P, Storme L, Ghesquiere L, Garabedian C. Umbilical cord arterial and venous gases, ionogram, and glucose level for predicting neonatal morbidity at term. Eur J Obstet Gynecol Reprod Biol 2020; 252:181-186. [PMID: 32622102 DOI: 10.1016/j.ejogrb.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine which parameter of umbilical arterial cord gas analysis, pH, base deficit, lactate concentration, ionogram values, or glucose level index is the best predictor of neonatal morbidity at term. DESIGN We conducted a 15-month retrospective cohort study that included all nonanomalous, singleton, term births at a single center. The predictive ability of lactate concentration, base deficit, pH, ionogram values, and glucose level were compared using receiver-operating characteristic curves for global and neurological composite morbidity. Optimal cutoff values for lactate concentration, base deficit, and pH were estimated based on their maximum area under the curve. RESULTS We included 5161 newborns: 52 (1.01 %) had global composite morbidity, and 17 had (0.33 %) neurological composite morbidity. Blood levels of potassium, calcium, natremia, glucose level, and HCO3- did not differ significantly between groups. pH, partial pressure of CO2, partial pressure of O2, base deficit, and lactate levels differed significantly between neonates in the groups with and without global composite morbidity. Nearly similar results were found for neurological composite morbidity. The predictive ability did not differ between arterial pH and arterial lactate concentration (P = .25) and base deficit (P = .79). Optimal cutoff values to predict global composite morbidity were arterial pH 7.144, venous pH 7.236, and arterial lactate concentration 6.5 mmol/L. CONCLUSIONS Acid-base status analysis remains the best objective indicator for predicting neonatal morbidity and can be estimated using pH, lactate, or base deficit. Ionogram cord blood composition and glucose level do not appear to be useful for this purpose.
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Affiliation(s)
- Roxane Vanspranghels
- CHU Lille, Department of Obstetrics, FHU "1000 Days for Health", F-59000 Lille, France.
| | | | - Valérie Deken
- Univ Lille, CHU Lille, EA 2694, Public Health: Epidemiology and Quality of Care, F-59000 Lille, France
| | - Thameur Rakza
- CHU Lille, Department of Obstetrics, FHU "1000 Days for Health", F-59000 Lille, France
| | - Patrice Maboudou
- CHU Lille, Biologic and Pathologic Center, F-59000 Lille, France
| | - Laurent Storme
- CHU Lille, Department of Neonatology, FHU "1000 Days for Health", F-59000 Lille, France
| | - Louise Ghesquiere
- CHU Lille, Department of Obstetrics, FHU "1000 Days for Health", F-59000 Lille, France
| | - Charles Garabedian
- CHU Lille, Department of Obstetrics, FHU "1000 Days for Health", F-59000 Lille, France
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14
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Amer-Wåhlin I, Ugwumadu A, Yli BM, Kwee A, Timonen S, Cole V, Ayres-de-Campos D, Roth GE, Schwarz C, Ramenghi LA, Todros T, Ehlinger V, Vayssiere C. Fetal electrocardiography ST-segment analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward. Am J Obstet Gynecol 2019; 221:577-601.e11. [PMID: 30980794 DOI: 10.1016/j.ajog.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the past century, some areas of obstetric including intrapartum care have been slow to benefit from the dramatic advances in technology and medical care. Although fetal heart rate monitoring (cardiotocography) became available a half century ago, its interpretation often differs between institutions and countries, its diagnostic accuracy needs improvement, and a technology to help reduce the unnecessary obstetric interventions that have accompanied the cardiotocography is urgently needed. STUDY DESIGN During the second half of the 20th century, key findings in animal experiments captured the close relationship between myocardial glycogenolysis, myocardial workload, and ST changes, thus demonstrating that ST waveform analysis of the fetal electrocardiogram can provide information on oxygenation of the fetal myocardium and establishing the physiological basis for the use of electrocardiogram in intrapartum fetal surveillance. RESULTS Six randomized controlled trials, 10 meta-analyses, and more than 20 observational studies have evaluated the technology developed based on this principle. Nonetheless, despite this intensive assessment, differences in study protocols, inclusion criteria, enrollment rates, clinical guidelines, use of fetal blood sampling, and definitions of key outcome parameters, as well as inconsistencies in randomized controlled trial data handling and statistical methodology, have made this voluminous evidence difficult to interpret. Enormous resources spent on randomized controlled trials have failed to guarantee the generalizability of their results to other settings or their ability to reflect everyday clinical practice. CONCLUSION The latest meta-analysis used revised data from primary randomized controlled trials and data from the largest randomized controlled trials from the United States to demonstrate a significant reduction of metabolic acidosis rates by 36% (odds ratio, 0.64; 95% confidence interval, 0.46-0.88) and operative vaginal delivery rates by 8% (relative risk, 0.92; 95% confidence interval, 0.86-0.99), compared with cardiotocography alone.
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15
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Leinonen E, Gissler M, Haataja L, Andersson S, Rahkonen P, Rahkonen L, Metsäranta M. Umbilical artery pH and base excess at birth are poor predictors of neurodevelopmental morbidity in early childhood. Acta Paediatr 2019; 108:1801-1810. [PMID: 30955219 DOI: 10.1111/apa.14812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
Abstract
AIM We sought to evaluate the associations between umbilical artery pH and base excess and neurodevelopmental outcome at four years of age. METHODS This study comprised 84 588 singleton children born alive at term in 2005-2011 in the hospital district of Helsinki and Uusimaa in Finland. Data from the maternity hospital information system were linked to the data from the Medical Birth Register and the Hospital Discharge Register. Neurodevelopmental morbidity included cerebral palsy, epilepsy, intellectual or sensorineural impairment. RESULTS After adjustment for maternal and perinatal factors, a combination of pH <7.00 and base excess <-16.00 was associated with infant death (adjusted odds ratio 19.97; 95% confidence interval 5.38-74.17). Values of pH 7.00-7.10 were associated with cerebral palsy (adjusted odds ratio 2.40; 95% confidence interval 1.05-5.47). A combination of low five-minute Apgar score and umbilical artery base excess <-16.00 showed the highest positive predictive value (9.1%) for neurodevelopmental impairments. When umbilical artery pH <7.00 was included, a positive predictive value of 25.0% was observed for infant mortality. CONCLUSION Low umbilical artery pH and base excess at birth were the poor predictors of long-term neurodevelopmental morbidity in an unselected population. However, these parameters might be useful in assessing the risk of infant mortality.
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Affiliation(s)
- Elina Leinonen
- Children's Hospital Paediatric Research Centre Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Mika Gissler
- Information Services Department National Institute for Health and Welfare Helsinki Finland
- Department of Neurobiology, Care Sciences and Society Division of Family Medicine Karolinska Institute Stockholm Sweden
| | - Leena Haataja
- Children's Hospital Paediatric Research Centre Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Sture Andersson
- Children's Hospital Paediatric Research Centre Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Petri Rahkonen
- Children's Hospital Paediatric Research Centre Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynaecology Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Marjo Metsäranta
- Children's Hospital Paediatric Research Centre Helsinki University Hospital University of Helsinki Helsinki Finland
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16
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Zaigham M, Källén K, Olofsson P. Gestational age-related reference values for Apgar score and umbilical cord arterial and venous pH in preterm and term newborns. Acta Obstet Gynecol Scand 2019; 98:1618-1623. [PMID: 31318453 DOI: 10.1111/aogs.13689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/27/2019] [Accepted: 07/05/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Despite much literature on reference values of acid-base status in umbilical cord blood at birth, there are as yet no studies performed to determine gestational age-dependent references in cord venous blood and no studies on preterm acid-base standards. Similarly, the normal reference range of Apgar scores for term and preterm infants has not yet been determined. MATERIAL AND METHODS Data were obtained from the maternity units of Skåne University Hospital, Malmö and Lund, Sweden, from 2001 to 2010. Validated paired arterial and venous cord pH values were obtained from 27 175 newborns, of whom 18 584 had spontaneous, non-instrumental vaginal deliveries and a 5-minute Apgar score equal to or greater than the median value for the individual gestational week. Simple linear and polynomial regression analyses were performed. Values were reported as mean ± standard deviation and median with 2.5th and 97.5th percentiles. RESULTS Median 5-minute Apgar score was 7 for gestations shorter than 28 weeks, 8 for 28 weeks, 9 for 29-30 weeks, and 10 from 31 weeks onwards. A linear decline in pH for both cord arterial and venous blood was seen with advancing gestational age (P < 0.001). CONCLUSIONS Median 5-minute Apgar scores were <10 before 31 weeks of gestation. Both umbilical cord arterial and venous pH decreased linearly with increasing gestational age. Further studies are needed to show whether gestational age-related pH reference ranges might be preferred to fixed cut-offs in the estimation of umbilical cord acidemia at birth.
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Affiliation(s)
- Mehreen Zaigham
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Karin Källén
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Per Olofsson
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
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17
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Hafström M, Salvesen Ø, Kjellmer I. Boys and girls differ in symptoms and neurodevelopmental outcome after perinatal metabolic acidosis, a population-based study. Acta Paediatr 2019; 108:1427-1433. [PMID: 30565318 DOI: 10.1111/apa.14703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 01/16/2023]
Abstract
AIM To evaluate sex differences in infants born at term with metabolic acidosis with regard to perinatal health and symptomatology, and developmental outcome. METHODS From a population-based cohort of infants born at term (n = 14 687), 78 were prospectively identified as having metabolic acidosis at birth. Two matched controls per case were selected. Sex differences in perinatal characteristics and in neurodevelopmental outcome at 6.5 years of age were analysed. Subgroup analysis was made based on need of neonatal care and planned follow-up. RESULTS Acidotic boys who appeared healthy, that is with no need of specialised neonatal care respectively only followed at ordinary health care service, have worse perinatal symptoms and less favourable neurodevelopmental outcome compared to girls. The male disadvantage concerning neurodevelopmental outcome was also indicated in children without acidosis. Outcome at 6.5 years was associated with Apgar at 10 minutes (p = 0.03), need of neonatal care (p = 0.04) and sex (p = 0.02) but not acidosis per se (p = 0.54). CONCLUSION Sex affected immediate symptomatology in term acidotic infants and neurodevelopmental outcome at the age of 6.5 years. The findings were seen in those who appeared healthy in the neonatal period. The results suggest that sex should be considered in assessment of acidotic children.
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Affiliation(s)
- Maria Hafström
- Department of Paediatrics; Institute of Clinical Science; University of Gothenburg; Gothenburg Sweden
- Department of Paediatrics; St Olavs Hospital; Trondheim Norway
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology Trondheim; Trondheim Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing; Norwegian University of Science and Technology Trondheim; Trondheim Norway
| | - Ingemar Kjellmer
- Department of Paediatrics; Institute of Clinical Science; University of Gothenburg; Gothenburg Sweden
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18
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Skiöld B, Petersson G, Ahlberg M, Stephansson O, Johansson S. Population-based reference curve for umbilical cord arterial pH in infants born at 28 to 42 weeks. J Perinatol 2017; 37:254-259. [PMID: 27906196 DOI: 10.1038/jp.2016.207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/15/2016] [Accepted: 10/12/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of the study was to examine normal variations of umbilical cord arterial pH by gestational age (GA). STUDY DESIGN Population-based cohort study of 46 199 infants born from 2008 to 2014 in Stockholm, Sweden, with GA 28 to 42 weeks, Apgar score ⩾7 at 5 min, non-instrumental vaginal delivery, and birth weight for GA⩾3rd and ⩽97th percentile. Quantile regression was used to investigate the associations between GA and infant sex, and pH. RESULTS The mean umbilical cord arterial pH (s.d.) was 7.29 (0.10), 7.27 (0.07), 7.25 (0.07) and 7.23 (0.07) among infants born at 28 to 31, 32 to 36, 37 to 41 and 42 weeks, respectively. Arterial pH decreased linearly with increasing GA, and female infants had higher pH than male infants (P<0.001). CONCLUSION Umbilical cord arterial pH varied in a linear fashion by GA and was influenced by infant sex. The provided reference curve taking GA into account may yield a more accurate definition of acidosis at birth.
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Affiliation(s)
- B Skiöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - G Petersson
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - M Ahlberg
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - O Stephansson
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,School of Public Health, University of California, Berkeley, CA, USA
| | - S Johansson
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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19
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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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20
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Risk factors for emergency caesarean section in planned vaginal breech delivery. Arch Gynecol Obstet 2016; 295:51-58. [PMID: 27631406 DOI: 10.1007/s00404-016-4190-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify risk factors for emergency caesarean section in women attempting a vaginal breech delivery at term. METHODS Data from 1092 breech deliveries performed between 1998 and 2013 at a Swiss cantonal hospital were extracted from an electronic database. Of the 866 women with a singleton, full term pregnancy, 464 planned a vaginal breech delivery. Fifty-seven percent (265/464) were successful in delivering vaginally. Multivariate regression analyses of risk factors were performed, and neonatal and maternal complications were compared. RESULTS Risk factors for failed vaginal delivery were peridural anaesthesia (OR 2.05; 95 % CI 1.09-3.84; p = 0.025), nulliparity (OR 2.82; 95 % CI 1.87-4.25; p < 0.001), high birth weight (OR 1.17; 95 % CI 1.04-1.30; p = 0.006) and induction of labour (OR 1.56; 95 % CI 1.003-2.44; p = 0.048). Maternal age, height and weight; gestational age; or newborn length and head circumference were not associated with an unplanned caesarean section. The rate of successful vaginal delivery in the low risk sub-group (multiparous women without induction of labour) was 58-83 %, depending on birth weight category. The likelihood of success for the high risk sub-group (nulliparous women with induction of labour) fell below a third at neonatal birth weights >3250 g. Complication rates were low in the cohort. CONCLUSIONS Use of peridural anaesthesia, nulliparity, high birth weight and induction of labour were risk factors for unsuccessful vaginal breech delivery requiring an unplanned caesarean section. Awareness of these risk factors is useful when counselling women who are considering a vaginal breech delivery.
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Limitations in the Activity of Mobility at Age 6 Years After Difficult Birth at Term: Prospective Cohort Study. Phys Ther 2016; 96:1225-33. [PMID: 26847013 DOI: 10.2522/ptj.20150201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 01/24/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND A difficult birth at term (DBAT) may manifest as fetal acidosis and low Apgar scores and is often referred to as "perinatal asphyxia," especially when infants show signs of neonatal encephalopathy (NE). In contrast to DBAT resulting in moderate-to-severe NE, which is associated with neurodevelopmental disorders, little is known about the prognosis of less severe forms of DBAT, with or without NE. OBJECTIVE The purpose of this study was to evaluate the International Classification of Functioning, Disability and Health, Children & Youth Version activity "mobility" and other neurodevelopmental sequelae in infants with DBAT at age 6 years. METHODS The index cohort (n=62; 35 boys, 27 girls) consisted of consecutive term infants with DBAT based on clinical criteria in a Dutch nonacademic hospital from 1999 to 2005. Neonatal encephalopathy was assessed according to the Sarnat grading system and excluded infants with severe NE. The matched reference cohort (n=81; 49 boys, 32 girls) consisted of healthy term infants. The primary outcome at 6 years was limited mobility (Movement Assessment Battery for Children score ≤15th percentile). Secondary outcomes included learning and behavioral problems and the presence of minor neurological dysfunction. RESULTS Three children developed cerebral palsy and were excluded from analyses. Children with DBAT more often had limited mobility than children without DBAT (risk ratio [RR]=2.44; 95% confidence interval [95% CI]=1.16, 5.14). The risk of limited mobility rose with increasing severity of NE (mild NE: RR=3.38; 95% CI=1.40, 8.16; moderate NE: RR=4.00; 95% CI=1.54, 10.40), and manual abilities especially were affected (RR=4.12; 95% CI=1.40, 12.14). Learning problems, need for physical therapy, and complex minor neurological dysfunction were more common in children with DBAT than in children without DBAT. CONCLUSIONS Term infants who develop mild or moderate NE following DBAT are at increased risk for limited mobility at age 6 years. Routine monitoring of neuromotor development in these children is warranted.
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Perinatal inflammation/infection and its association with correction of metabolic acidosis in hypoxic-ischemic encephalopathy. J Perinatol 2016; 36:448-52. [PMID: 26796123 PMCID: PMC4882262 DOI: 10.1038/jp.2015.221] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/10/2015] [Accepted: 12/17/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the decreased response to hypothermia in neonates with hypoxic-ischemic encephalopathy (HIE) and infection, we sought to determine the association of fetal inflammation/infection with perinatal metabolic acidosis. STUDY DESIGN We performed a retrospective cohort study of neonates with suspected HIE started on whole-body hypothermia within 6 h of birth that had a cord gas at delivery and placental pathology performed. Neonates were compared based on the presence of clinical and histologic chorioamnionitis. The cord gas at delivery was compared with the initial arterial gas after birth. RESULTS In all, 50 out of 67 (74.6%) neonates admitted for therapeutic hypothermia met inclusion criteria. Chorioamnionitis did not affect the cord gas at delivery, but both clinical and histologic chorioamnionitis were associated with a significantly increased metabolic acidosis on the initial neonatal arterial gas. CONCLUSION Chorioamnionitis, diagnosed both clinically and histologically, is associated with a persistent state of acidosis in neonates with HIE that may contribute to worse neurologic outcomes.
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Kessler J, Yli BM, Stray-Pedersen B, Jacobsen AF, Saugstad OD, Henriksen T. Why did the authors perform a meta-analysis of studies with primary endpoints they consider clinically unimportant? Acta Obstet Gynecol Scand 2016; 95:606-7. [DOI: 10.1111/aogs.12876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jörg Kessler
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
- Research Group for Pregnancy, Fetal Development and Birth; Department of Clinical Science; University of Bergen; Bergen Norway
| | - Branka M. Yli
- Department of Obstetrics and Gynecology; Oslo, University Hospital; Oslo Norway
| | - Babill Stray-Pedersen
- Department of Obstetrics and Gynecology; Oslo, University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Anne Flem Jacobsen
- Department of Obstetrics and Gynecology; Oslo, University Hospital; Oslo Norway
| | | | - Tore Henriksen
- Department of Obstetrics and Gynecology; Oslo, University Hospital; Oslo Norway
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Blix E, Brurberg KG, Reierth E, Reinar LM, Øian P. ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials. Acta Obstet Gynecol Scand 2015; 95:16-27. [DOI: 10.1111/aogs.12828] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ellen Blix
- Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Kjetil G. Brurberg
- The Norwegian Knowledge Center for the Health Services; Oslo Norway
- Center for Evidence Based Practice; Bergen University College; Bergen Norway
| | - Eirik Reierth
- Science and Health Library; University Library; UiT The Arctic University of Norway; Tromsø Norway
| | - Liv M. Reinar
- The Norwegian Knowledge Center for the Health Services; Oslo Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Medicine; UiT The Arctic University of Norway; Tromsø Norway
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Olofsson P. Determination of base excess in umbilical cord blood at birth: accessory or excess? Am J Obstet Gynecol 2015; 213:259-61. [PMID: 26320374 DOI: 10.1016/j.ajog.2015.06.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Per Olofsson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, and Institution of Clinical Sciences, Lund University, Malmö, Sweden.
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Metabolic acidosis in the first 14 days of life in infants of gestation less than 26 weeks. Eur J Pediatr 2015; 174:49-54. [PMID: 24969340 DOI: 10.1007/s00431-014-2364-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/31/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Extremely immature newborns develop a self-limiting normal anion gap metabolic acidosis in early life. This study examined the natural history of this acidosis in a population of infants of gestation less than 26 weeks in the first 14 days of life. The acidosis was maximal on day 4 with a mean base deficit of 10.6 mmol/l and had resolved in 90 % of infants by day 11. Dopamine usage was the only independent predictor of the acidosis. Its use was associated with a greater degree of acidosis. CONCLUSION Extremely preterm infants experience a self-limiting normal anion gap metabolic acidosis in the first 2 weeks of life which is consistent with renal tubular immaturity.
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Hilgendorff A. Diagnose und Behandlung der perinatalen Asphyxie. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3229-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Blix E, Øian P. Deviations from STAN guidelines are frequent but results cannot be excluded when the effectiveness of the method should be evaluated. Acta Obstet Gynecol Scand 2014; 93:589. [PMID: 24806544 DOI: 10.1111/aogs.12415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ellen Blix
- Department of Clinical Research, University Hospital of Northern Norway, Tromsø, Norway; Women's Health and Perinatology Research Group, University of Tromsø, Tromsø, Norway
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Kro GAB, Yli BM, Rasmussen S, Norèn H, Amer-Wåhlin I, Rosén KG, Stray-Pedersen B, Saugstad OD. Association between umbilical cord artery pCO₂ and the Apgar score; elevated levels of pCO₂ may be beneficial for neonatal vitality after moderate acidemia. Acta Obstet Gynecol Scand 2013; 92:662-70. [PMID: 23551012 DOI: 10.1111/aogs.12090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 12/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the association between 5-min Apgar score and umbilical cord artery carbon dioxide tension (pCO₂). DESIGN Observational study. SETTING European hospital labor wards. POPULATION Data from 36,432 newborns ≥36 gestational weeks were obtained from three sources: two trials of monitoring with fetal electrocardiogram (the Swedish randomized controlled trial and the European Union Fetal ECG trial) and Mölndal Hospital data. After validation of the acid-base values, 25,806 5-min Apgar scores were available for analysis. METHODS Validation of the umbilical cord acid-base values was performed to obtain reliable data. 5-min Apgar score was regressed against cord artery pCO₂ in a polynomial multilevel model. MAIN OUTCOME MEASURES Five-min Apgar score, umbilical cord pCO₂, pH, and base deficit. RESULTS Overall, a higher cord artery pCO₂ was found to be associated with lower 5-min Apgar scores. However, among newborns with moderate acidemia, lower umbilical cord artery pCO₂ (≤median pCO₂ for the specific cord artery pH) was associated with lower 5-min Apgar scores, with a relative risk of 2.0 (95% confidence interval: 1.4-2.8) for 5-min Apgar scores 0-6. CONCLUSIONS Metabolic acidosis affects the newborn's vitality more than respiratory acidosis. In addition, elevated levels of pCO₂ may be beneficial for fetuses with moderate acidemia, and thus cord artery pCO₂ is a factor that should be considered when assessing the compromised newborn.
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Affiliation(s)
- Grete A B Kro
- Women and Children's Division, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Relationship between severe acidemia, verbal abilities, and behavior in a Spanish cohort of 5-year-old children born at term. J Dev Behav Pediatr 2013; 34:102-10. [PMID: 23369957 DOI: 10.1097/dbp.0b013e31827d582a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine whether a relationship exists between the markers of severe acidemia (SA) and the developmental, verbal, and behavioral characteristics of children with SA born at term 5 years previously, without apparent neurological impairment. METHODS A cohort of 76 children-38 with SA (pH < 7, base deficit ≥12 mmol/L) and 38 non-SA (pH ≥ 7.20)-were evaluated using the Battelle Developmental Inventory, McCarthy's Verbal Scale, the Token Test for Children, and the Conners 3rd Edition-Parent. The relationships between markers of SA and verbal and behavioral scores were analyzed with parametric correlations. Multiple regression analysis was used to determine the possible effect of these markers on verbal abilities, verbal memory, and attention. RESULTS Although none of the scores were in the "impaired" range, the SA group scored lower in verbal index (p = .000) and verbal memory (p = .004) on the McCarthy's Scales and in verbal comprehension (p = .001) on the Token Test for Children-2, and higher on the inattention (p = .003) and hyperactivity-impulsivity domains of the Conners Scales (p = .009) compared with the control group. There were no differences between the groups in the motor, personal-social, or cognitive domains on the Battelle Developmental Inventory. The SA markers were found to be predictors, accounting for 61.6% of verbal variability. CONCLUSIONS SA markers reflect mild long-term consequences regarding verbal abilities and inattentiveness among children born at term without apparent neurological impairment on discharge but do not suggest severe impairment to the 5-year development of children. The authors recommend that these children should be monitored to determine whether they need or might benefit from an early intervention program.
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