Umbilical artery eucapnic pH to assess fetal well being.
Neonatal metabolic acidosis
cord gas
eucapnic pH
hypoxic-ischemic encephalopathy
newborn
Journal
American journal of obstetrics and gynecology
ISSN: 1097-6868
Titre abrégé: Am J Obstet Gynecol
Pays: United States
ID NLM: 0370476
Informations de publication
Date de publication:
03 Apr 2024
03 Apr 2024
Historique:
received:
16
10
2022
revised:
19
03
2024
accepted:
31
03
2024
medline:
6
4
2024
pubmed:
6
4
2024
entrez:
5
4
2024
Statut:
aheadofprint
Résumé
Umbilical artery gas results help obstetricians to assess fetal well being during the course of labor and guide screening decisions on eligibility for therapeutic hypothermia or also know as whole body or head cooling. The accuracy of results, especially base deficit on arterial cord gas analysis, in predicting brain injury is questioned. A novel biomarker specifically calculated for fetal acid-base physiology and response to asphyxia-neonatal eucapnic pH as a marker of neonatal metabolic acidosis-has the potential to be an accurate predictor of hypoxic-ischemic encephalopathy. We aimed to compare false-negative rates of hypoxic-ischemic encephalopathy for umbilical artery pH, base deficit, and neonatal eucapnic pH in assessing fetal acid-base balance as a marker of fetal well being and predicting acute brain injury. This is a retrospective single-center cohort study of newborns ≥ 35 weeks' gestation diagnosed with hypoxic-ischemic encephalopathy. We compared false-negative rates for any grade of hypoxic-ischemic encephalopathy using unilateral paired χ We included 113 newborns. False-negative rate for hypoxic-ischemic encephalopathy was significantly higher for base deficit < 16 mmol/ (n=78/113; 69.0%) compared to base deficit < 12 mmol/L (n=46/113; 40.7%), pH > 7.00 (n=41/113; 36.3%) or neonatal eucpanic pH > 7.14 (n=35/113; 31.0%) (p<0.0001). All true positive cases were identified using only umbilical artery pH and neonatal eucapnic pH. Base deficit ≥16 or ≥12 mmol/L did not add any value in identifying newborns with hypoxic-ischemic encephalopathy when using umbilical artery pH and neonatal eucapnic pH. No association emerged between any marker and hypoxic-ischemic encephalopathy severity grading. Our findings support the accuracy of neonatal eucapnic pH to assess fetal well being during labor and to improve predictive performance for acute brain injury. Neonatal eucpanic pH, in addition to umbilical artery pH, may be a viable alternative in identifying newborns at risk for hypoxic-ischemic encephalopathy.
Sections du résumé
BACKGROUND
BACKGROUND
Umbilical artery gas results help obstetricians to assess fetal well being during the course of labor and guide screening decisions on eligibility for therapeutic hypothermia or also know as whole body or head cooling. The accuracy of results, especially base deficit on arterial cord gas analysis, in predicting brain injury is questioned. A novel biomarker specifically calculated for fetal acid-base physiology and response to asphyxia-neonatal eucapnic pH as a marker of neonatal metabolic acidosis-has the potential to be an accurate predictor of hypoxic-ischemic encephalopathy.
OBJECTIVES
OBJECTIVE
We aimed to compare false-negative rates of hypoxic-ischemic encephalopathy for umbilical artery pH, base deficit, and neonatal eucapnic pH in assessing fetal acid-base balance as a marker of fetal well being and predicting acute brain injury.
STUDY DESIGN
METHODS
This is a retrospective single-center cohort study of newborns ≥ 35 weeks' gestation diagnosed with hypoxic-ischemic encephalopathy. We compared false-negative rates for any grade of hypoxic-ischemic encephalopathy using unilateral paired χ
RESULTS
RESULTS
We included 113 newborns. False-negative rate for hypoxic-ischemic encephalopathy was significantly higher for base deficit < 16 mmol/ (n=78/113; 69.0%) compared to base deficit < 12 mmol/L (n=46/113; 40.7%), pH > 7.00 (n=41/113; 36.3%) or neonatal eucpanic pH > 7.14 (n=35/113; 31.0%) (p<0.0001). All true positive cases were identified using only umbilical artery pH and neonatal eucapnic pH. Base deficit ≥16 or ≥12 mmol/L did not add any value in identifying newborns with hypoxic-ischemic encephalopathy when using umbilical artery pH and neonatal eucapnic pH. No association emerged between any marker and hypoxic-ischemic encephalopathy severity grading.
CONCLUSION
CONCLUSIONS
Our findings support the accuracy of neonatal eucapnic pH to assess fetal well being during labor and to improve predictive performance for acute brain injury. Neonatal eucpanic pH, in addition to umbilical artery pH, may be a viable alternative in identifying newborns at risk for hypoxic-ischemic encephalopathy.
Identifiants
pubmed: 38580045
pii: S0002-9378(24)00479-4
doi: 10.1016/j.ajog.2024.03.042
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Elsevier Inc. All rights reserved.