Laboratory and clinical indicators of the state of the newborn after birth

Česká verzia

Authors: M. Větr
Authors place of work: Gynekologicko-porodnická klinika FN, Olomouc, přednosta doc. MUDr. Radovan Pilka, Ph. D.
Published in the journal: Ceska Gynekol 2010; 75(5): 447-454

Summary

Objectives:
Analysis of the prevalence of neonatal adaptation after birth. Evaluation of indicators used and determining the levels of laboratory findings. Evaluation of benefits of commonly used indicators of the newborn condition in clinical practice.

Design:
Retrospective epidemiological study.

Setting:
Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc.

Methods:
Analysis of records of 18,208 live births in the ten-year period from 1. 1. 2000 to 31 12. 2009 - Inclusion criteria (complete data) fulfill 15 755 (86.5%) neonates.

Results:
In the whole set (n = 15 755) the prevalence of pathological values of one-minute Apgar score (less than 7 points) was 5.4%, one per cent at 5 minutes and 0.2% at 10 minutes. Five-minute Apgar score of less than 4 points was in 23 (0.2%) newborns. Values below pH arterial cord blood under 7.00 (acidosis criterion ACOG) had 93 (0.6%) newborns.

Analysis of lactate acidemia results relevant to a pH below 7.00 set lactate cutoff = 6.7 mmol / L (area under ROC curve 0.977). Prevalence findings lactate above 6.7 mmol / l is 7.2%. 93.5% of newborns in the group of newborns with a pH below 7.00 had a lactate above 6.7 mmol / l. In the whole set was moderate correlation of pH and lactate (r = -0,4318; 95% CI 0,4444 to –0,4190; P < 0,0001). Weak was the correlation of lactate and pH mesurements to the clinical evaluation of the newborn. Comparing the two indicators of acidosis using method of „Gold standard“ confirmed the higher sensitivity of lactate values above 6.7 mmol / l compared to pH <7.00 in relation to very low values of Apgar at 5 minutes.

Conclusion:
The results obtained confirm that acidemia after birth is relatively frequent, but not always echoed in the clinical condition of the newborn after birth. Assessing the diagnostic importance of lactate shows better results in relation to the clinical status of newborns and values above 6.7 mmol / l can be regarded as an important clinical indicator of neonatal acidosis. Determination of lactate levels is not an alternative for the examination of the newborns, but in combination with other indicators improve standard for evaluation of newborns.

Key words:
Apgar score, umbilical arterial pH, lactate, comparison.

Zdroje

1. Abessolo, FO., Ngou, JP., Meye, JF., et al. Fetal distress: Information provided by lactate levels and antioxidant status, compared with the Apgar score. Sante. 2009, 19, 1, p. 15-19.

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

3. Basu, P., Som, S., Choudhuri, N., Das, H. Contribution of the blood glucose level in perinatal asphyxia. Eur J Pediatr, 2009, 168, 7, p. 833-838.

4. Berglund, S., Grunewald, C., Pettersson, H., Cnattingius, S. Risk factors for asphyxia associated with substandard care during labor. Acta Obstet Gynecol Scand, 2010, 89, 1, p. 39-48.

5. Borruto, F., Comparetto, C., Treisser, A. Prevention of cerebral palsy during labour: role of foetal lactate. Arch Gynecol Obstet, 2008, 278, 1, p. 17-22.

6. Buchmann, EJ., Velaphi, SC. Confidential enquiries into hypoxic ischaemic encephalopathy. Best Pract Res Clin Obstet Gynaecol, 2009, 23, 3, p. 357-368.

7. Dzakpasu, S., Joseph, KS., Huang, L., et al. Decreasing diagnoses of birth asphyxia in Canada: fact or artifact. Pediatrics, 2009, 123, 4, p. 668-672.

8. Evers, AC., van Leeuwen, J., Kwee, A., et al. Mortality and morbidity among full-term neonates in a neonatal intensive care unit in the Utrecht region, the Netherlands. Ned Tijdschr Geneeskd, 2010, 154, 7, A118.

9. Fox, NS., Silverstein, M., Bender, S., et al. Active second-stage management in twin pregnancies undergoing planned vaginal delivery in a U.S. population. Obstet Gynecol, 2010, 115, 2 Pt 1, p. 229-233.

10. Gao, C., Yuan, L., Wang, J. Role of pH value of umbilical artery blood in neonatal asphyxia] Zhongguo Dang Dai Er Ke Za Zhi, 2009, 11, 7, p. 521-524.

11. García-Alix, A., Martínez-Biarge, M., Diez, J., et al. Neonatal hypoxic-ischemic encephalopathy: Incidence and prevalence in the first decade of the 21st century. An Pediatr (Barc), 2009, 71, 4, p. 319-326.

12. Gelot, A., Villapol, S., Billette de Villemeur, T., et al. Astrocytic demise in the developing rat and human brain after hypoxic-ischemic damage. Dev Neurosci, 2009, 31, 5, p. 459-470.

13. Ghazi, A., Ali, T., Jabbar, S., et al. Perinatal mortality contributors in singleton gestation. J Coll Physicians Surg Pak, 2009, 19, 11, p. 711-713.

14. Groenendaal, F., Lindemans, C., Uiterwaal, CS., Boog, G. Early arterial lactate and prediction of outcome in preterm neonates admitted to a neonatal intensive care unit. Biol Neonate, 2003, 83, 3, p. 171-176.

15. Hájek, Z., Srp, B., Pavlíková, M., et al. Intrapartální fetální monitoring, senzitivita a specificita metod. Čes Gynek, 2006, 71, 4, s. 263-267.

16. Halliday, HL. Neonatal management and long-term sequelae. Best Pract Res Clin Obstet Gynaecol, 2009, 23, 6, p. 871-880.

17. Hirst, JJ., Walker, DW., Yawno, T., Palliser, HK. Stress in pregnancy: a role for neuroactive steroids in protecting the fetal and neonatal brain. Dev Neurosci, 2009, 31, 5, p. 363-377.

18. Hruban, L., Janků, P., Zahradníčková, J., et al. Význam ST-analýzy fetálního EKG při intrapartálním monitorování plodů s předpokládanou růstovou retardací. Čes Gynek, 2006, 71, 4, s. 268-272.

19. Joss-Moore, LA., Metcalfe, DB., Albertine, KH., et al. Epigenetics and fetal adaptation to perinatal events: Diversity through fidelity. J Anim Sci, 2010, 88, 13 Suppl, p. 216-222.

20. Kennare, RM., Keirse, MJ., Tucker, GR., Chan, AC. Planned home and hospital births in South Australia, 1991-2006: differences in outcomes. Med J Aust, 2010, 192, 2, p. 76-80.

21. Laptook, AR., Shankaran, S., Ambalavanan, N., et al. Outcome of term infants using apgar scores at 10 minutes following hypoxic-ischemic encephalopathy. Pediatrics, 2009, 124, 6, p. 1619-1626.

22. Lawn, JE., Kinney, M., Lee, AC., et al. Reducing intrapartum-related deaths and disability: can the health system deliver? Int J Gynaecol Obstet, 2009, 107, Suppl 1, p. 123-142.

23. Linet, T., Laporte, J., Gueye, H., Boog, G. Microvolume dosage of lactate in cord blood for the evaluation of the neonatal well-being. J Gynecol Obstet Biol Reprod (Paris), 2002, 31, 4, p. 352-357.

24. Logitharajah, P., Rutherford, MA., Cowan, FM. Hypoxic-ischemic encephalopathy in preterm infants: antecedent factors, brain imaging, and outcome. Pediatr Res, 2009, 66, 2, p. 222-229.

25. Longo, M., Hankins, GD. Defining cerebral palsy: pathogenesis, pathophysiology and new intervention. Minerva Ginecol, 2009, 61, 5, p. 421-429.

26. Montassir, H., Maegaki, Y., Ogura, K., et. al. Associated factors in neonatal hypoglycemic brain injury. Brain Dev, 2009, 31, 9, p. 649-656.

27. Odd, DE., Lewis, G., Whitelaw, A., Gunnell, D. Resuscitation at birth and cognition at 8 years of age: a cohort study. Lancet, 2009, 373, 9675, p. 1615-1622.

28. Ojha, RK., Singh, SK., Batra, S., et al. Lactate: creatinine ratio in babies with thin meconium staining of amniotic fluid. BMC Pediatr, 2006, 20, 6, p. 13.

29. Oztekin, D., Aydal, I., Oztekin, O., et al. Predicting fetal asphyxia in intrahepatic cholestasis of pregnancy. Arch Gynecol Obstet, 2009, 280, 6, p. 975-979.

30. Pasupathy, D., Wood, AM., Pell, JP., et al. Rates of and factors associated with delivery-related perinatal death among term infants in Scotland. JAMA, 2009, 302, 6, p. 660-668.

31. Pin, TW., Eldridge, B., Galea, MP. A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy. Eur J Paediatr Neurol, 2009, 13, 3, p. 224-234.

32. Pinheiro, JM. The Apgar cycle: a new view of a familiar scoring system. Arch Dis Child Fetal Neonatal, 2009, 94, 1, p. 70-72.

33. Pisani, F., Orsini, M., Braibanti, S., et al. Development of epilepsy in newborns with moderate hypoxic-ischemic encephalopathy and neonatal seizures. Brain Dev, 2009, 31, 1, p. 64-68.

34. Ramanah, R., Martin, A., Clement, MC., et al. Fetal scalp lactate microsampling for non-reassuring fetal status during labor: a prospective observational study. Fetal Diagn Ther, 2010, 27, 1, p. 14-19.

35. Shah, PS., Perlman, M. Time courses of intrapartum asphyxia: neonatal characteristics and outcomes. Am J Perinatol, 2009, 26, 1, p. 39-44.

36. Schneider, H. Significance of intrapartum asphyxia for the onset of fetal brain damage. Geburtshilfe Frauenheilkd, 1993, 53, 6, p. 369-378.

37. Suzuki, J., Miyajima, T., Fujii, T. Epidemiological study of cerebral palsy in Shiga Prefecture, Japan, during 1977-2000. Part 2: etiologies and risk factors of cerebral palsy in Shiga prefecture. No To Hattatsu, 2009, 41, 4, p. 284-288.

38. Tasnim, N., Mahmud, G., Akram, S. Predictive accuracy of intrapartum cardiotocography in terms of fetal Acid base status at birth. 2009, 19, 10, p. 632-635.

39. Vakrilova, L., Elleau, Ch., Sluncheva, B. French-Bulgarian program „Resuscitation of the newborn in a delivery room“ - results and perspectives. Akush Ginekol, 2005, 44, 3, p. 35-40.

40. Vukojevič, M., Soldo, I., Granič, D. Risk factors associated with cerebral palsy in newborns. Coll Antropol, 2009, 33, Suppl 2, p. 199-201.