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Birth hypoxia


Authors: Doc. MUDr. Miroslav Větr, CSc.
Authors‘ workplace: Porodnicko-gynekologická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D.
Published in: Ceska Gynekol 2015; 80(2): 115-126

Overview

Objective:
Evaluation of the commonly used laboratory and clinical parameters of the newborn shortly after birth. Check thresholds acidemia, and in relation to the method of termination of pregnancy.

Design:
Retrospective epidemiological study.

Setting:
Department of Obstetrics and Gynecology, University Hospital, Olomouc.

Methods:
Of the 26,869 children born in the years 2000 to 2013 Inclusion criteria (complete clinical and laboratory findings after birth) fulfill 23,471 (87.4%) neonates. Methods for evaluation of newborns included Apgar score calculation and arterial umbilical cord blood pH and lactate analysis.

Results:
A total of 0.7% (157) of the neonates had severe acidosis pH below 7.00 arterial umbilical cord blood, its prevalence varies annually between 0.1 to 1.1%. Cutoff lactate in relation to pH < 7.00 was 6.3 mmol/l (n = 23 471, the sensitivity of 92.99%, specificity 92.15%, AUC = 0.972).

For children of low weight < 2500 g the cutoff value is lower, 5.3 mmol/l (n = 2592, 89.66% sensitivity, specificity 91.10% AUC = 0.912). Suprathreshold lactate values was 8.4% (1977) newborns. Correlation of pH and lactate to Apgar evaluation is very low and in the range from 1 to 10 minutes gradually decreases.

Worse Apgar evaluation in children of low birth weight do not correspond to laboratory findings acidosis, which is probably related to prematurity and lower energy reserves. Operating cesarean births in particular accounts for more than half of those with worse clinical findings Apgar and pH <7.00, but only 30% supratreshold lactate values. Also worse clinical evaluation after caesarean section is not in accordance with the laboratory findings. Vaginal surgery, especially forceps have a significant share of severe acidosis than cesarean, regardless of their frequency. Risc factor of forceps to pH less 7.00,OR = 9.28 (5.39 -15.77), P = 0.0000000, while caesarean to pH less 7,00 had OR = 1.52 (1.08 to 2.14), P = 0.01408156.

Conclusion:
The results obtained confirm that acidosis after birth is quite common, although they may not have response on the clinical condition of the newborn after birth. Evaluation of Apgar is little objective for the detection of hypoxia during birth and is influenced by the immaturity of newborn and method of delivery. Lactate levels may contribute to an objective assessment of hypoxia during birth. Values above 6.3 mmol/l can be considered an important indicator of newborn acidosis and birth hypoxia.

Keywords:
Apgar score, umbilical arterial pH, lactate, low birth weight, mode of delivery


Sources

1. American College of Obstetricians and Gynecologists. Assessment of fetal and newborn acid-base status. ACOG Technical Bulletin, 1989, 127, p. 1–4.

2. Anand, V., Nair, PM. Neonatal seizures: Predictors of adverse outcome. J Pediatr Neurosci, 2014, 9, 2, p. 97–99.

3. Ancora, G., Soffritti, S., Lodi, R., et al. A combined a-EEG and MR spectroscopy study in term newborns with hypoxic-ischemic encephalopathy. Brain Dev, 2010, 32, 10, p. 835–842.

4. Batlle, L., Guyard-Boileau, B., Thiebaugeorges, O., et al. Analysis of the evitability of intrapartum asphyxia with a peers review. J Gynecol Obstet Biol Reprod (Paris), 2013, 42, 6, p. 550–556.

5. Biringer, K., Danko, J., Dókuš, K., et al. Biochemické aspekty fetálnej hypoxie. Čes Gynek, 2011, 76, 4, s. 285–291.

6. Boog G. Cerebral palsy and perinatal asphyxia (II-Medicolegal implications and prevention). Gynecol Obstet Fertil, 2011, 39, 3, p. 146–173.

7. Corbo, ET., Bartnik-Olson, BL., Machado, S., et al. The effect of whole-body cooling on brain metabolism following perinatal hypoxic-ischemic injury. Pediatr Res, 2012, 71, 1, p. 85–92.

8. Drobyshevsky, A., Jiang, R., Lin, L., et al. Unmyelinated axon loss with postnatal hypertonia after fetal hypoxia. Ann Neurol, 2014, 75, 4, p. 533–541.

9. Drury, PP., Gunn, ER., Bennet, L., et al. Mechanisms of hypothermic neuroprotection. Clin Perinatol, 2014, 41, 1, p. 161–175.

10. East, CE., Leader, LR., Sheehan, P., et al. Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev, 2010, 3, CD006174.

11. Hamed, HO. Intrapartum fetal asphyxia: study of umbilical cord blood lactate in relation to fetal heart rate patterns. Arch Gynecol Obstet, 2013, 287, 6, p. 1067–1073.

12. Hayakawa, M., Ito, Y., Saito, S., et al. Incidence and prediction of outcome in hypoxic-ischemic encephalopathy in Japan. Pediatr Int, 2014, 56, 2, p. 215–221.

13. Helsmoortel, A., Schmitt, E., Hascoët, JM., et al. Neonatal therapeutic hypothermia: amplitude-integrated electroencephalography to confirm the indication. Arch Pediatr, 2013, 20, 2, p. 181–185.

14. Holzmann, M., Cnattingius, S., Nordström, L. Lactate production as a response to intrapartum hypoxia in the growth-restricted fetus. BJOG, 2012, 119, 10, p. 1265–1269.

15. Howell, EA., Zeitlin, J., Hebert, PL., et al. Association between hospital-level obstetric quality indicators and maternal and neonatal morbidity. JAMA, 2014 , 312, 15, p. 1531–1541.

16. Mann, C., Latal, B., Padden, B., et al. Acid-base parameters for predicting magnetic resonance imaging measures of neurologic outcome after perinatal hypoxia-ischemia: is the strong ion gap superior to base excess and lactate? Am J Perinatol, 2012, 29, 5, p. 361–368.

17. McClendon, E., Chen, K., Gong, X., et al. Prenatal cerebral ischemia triggers dysmaturation of caudate projection neurons. Ann Neurol, 2014, 75, 4, p. 508–524.

18. Paris, A., Maurice-Tison, S., Coatleven, F., et al. Interest of lactate micro-dosage in scalp and umbilical cord in cases of abnormal fetal heart rate during labor. Prospective study on 162 patients. J Gynecol Obstet Biol Reprod (Paris), 2012, 41, 4, p. 324–332.

19. Racinet, C., Richalet, G., Corne, C., et al. Diagnosis of neonatal metabolic acidosis by eucapnic pH determination. Gynecol Obstet Fertil, 2013, 41, 9, p. 485–492.

20. Robertson, NJ., Faulkner, S., Fleiss, B., et al. Melatonin augments hypothermic neuroprotection in a perinatal asphyxia model. Brain, 2013, 136, Pt 1, p. 90–105.

21. Robertson, NJ., Kato, T., Bainbridge, A., et al. Methyl-isobutyl amiloride reduces brain Lac/NAA, cell death and microglial activation in a perinatal asphyxia model. J Neurochem, 2013, 124, 5, p. 645–657.

22. Ross, MG., Jessie, M., Amaya, K., et al. Correlation of arte-rial fetal base deficit and lactate changes with severity of variable heart rate decelerations in the near-term ovine fetus. Am J Obstet Gynecol, 2013, 208, 4, 285, s. e1–6.

23. Su, TY., Reece, M., Chua, SC. Lactate study using umbilical cord blood: agreement between Lactate Pro hand-held devices with blood gas analyser and evaluation of lactate stability over time. Aust N Z J Obstet Gynaecol, 2013, 53, 4, 375–380.

24. Surmiak, P., Baumert, M., Fiala, M., et al. Umbilical cordblood NGAL concentration as an early marker of perinatal asphyxia in neonates. Ginekol Pol, 2014, 85, 6, s. 424–427.

25. Torrance, HL., Pistorius, L., Voorbij, HA., et al. Lactate to creatinine ratio in amniotic fluid: a pilot study. J Matern Fetal Neonatal Med, 2013, 26, 7, p. 728–730.

26. Uria-Avellanal, C., Robertson, NJ. Na+/H+ exchangers and intracellular pH in perinatal brain injury. Transl Stroke Res, 2014, 5, 1, p. 79–98.

27. Varkilova, L., Slancheva, B., Emilova, Z., et al. Blood lactate measurments as a diagnostic and prognostic tool after birth asphyxia in newborn infants with gestational age > or = 34 gestational weeks. Akush Ginekol (Sofiia).,2013, 52, 3, s. 36–43.

28. Větr, M. Laboratorní a klinické ukazatelé stavu novorozence po porodu. Čes Gynek, 2010, 75, 5 s. 447–454.

29. White, CR., Doherty, DA., Newnham, JP., et al. The impact of introducing universal umbilical cord blood gas analysis and lactate measurement at delivery. Aust N Z J Obstet Gynaecol, 2014, 54, 1, p. 71–78.

30. Whitehead, C., Teh, WT., Walker, SP., et al. Quantifying circulating hypoxia-induced RNA transcripts in maternal blood to determine in utero fetal hypoxic status. BMC Med, 2013, 9, 11, p. 256.

31. Wiberg-Itzel, E., Lipponer, C., Norman, M., et al. Deter-mination of pH or lactate in fetal scalp blood in managementof intrapartum fetal distress: randomised controlled multicentre trial. BMJ, 2008, 336, 7656, p. 1284–1287.

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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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