The effect of profound umbilical artery acidemia in term neonates admitted to a newborn nursery
The effect of profound umbilical artery acidemia in term neonates admitted to a newborn nursery
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DOI：
10.1016/s0022-3476(98)70350-6
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发表时间：
1998-04-01
影响因子：
5.1
通讯作者：
Laptook, AR
中科院分区：
文献类型：
--
作者：
King, TA;Jackson, GL;Laptook, AR
目的：确定脐动脉pH值小于或等于7.0是否对足月和近足月婴儿有直接的不良影响。研究设计：对1993年5月至1994年4月期间所有脐动脉pH值小于或等于7.0的婴儿（n = 37）进行前瞻性鉴定; 37名婴儿中的35名入组，并与非酸血症对照婴儿（n = 35）匹配。器官系统功能障碍（神经，肾，肝，胃肠道）进行了评估，无论是临床或生化与选定的血液和尿液parameters.Results：酸血症和对照组是相似的妊娠并发症分娩前，但酸血症的婴儿更经常通过剖宫产（20/35与6/35，P = 0.001）。在胎龄、出生体重、神经系统评估、听力缺陷、喂养耐受性和肝功能方面，酸血症和对照组婴儿之间没有差异。在出生后第2天，酸血症组的平均血清肌酐高于对照组婴儿（0.90 +/- 0.34 vs 0.71 +/- 0.12 mg/dl，p = 0.005），尿化学试纸血红素阳性的婴儿数量也更多（14/35 vs 3/35，p = 0.005）。两组之间没有差异存在的时间，第一次排尿，尿比重，显微镜下血尿的婴儿数量。结论：足月和近足月出生的婴儿脐动脉pH值小于或等于7.0和分流到新生儿托儿所的基础上，一个稳定的外观在产房没有缺氧缺血的临床表现在出生后48小时。与对照组相比，酸血症组的平均血清肌酐较高，推测其起源于肾前性，是导致胎儿严重酸血症的过程的结果。脐动脉pH值小于或等于7.0且经评估临床状况良好的婴儿可接受与无酸血症婴儿相似的治疗。
Objective: To determine whether there were immediate adverse effects of an umbilical artery pH less than or equal to 7.0 in term and near-term infants.Study design: All infants triaged to the newborn nursery with an umbilical artery pH less than or equal to 7.0 from May 1993 through April 1994 (n = 37) were prospectively identified; 35 of the 37 infants were enrolled and matched with nonacidemic control infants (n = 35). Organ system dysfunction (neurologic, renal, hepatic, gastrointestinal) was evaluated either clinically or biochemically with selected blood and urine parameters.Results: Acidemic and control groups were similar for pregnancy complications before labor, but acidemic infants were more often delivered by cesarean section (20/35 vs 6/35, p = 0.001). No differences existed between acidemic and control infants in gestational age, birth weight, neurologic evaluations, hearing deficits, feeding tolerance, and hepatic function. The acidemic group had a higher mean serum creatinine than control infants on day 2 of life (0.90 +/- 0.34 vs 0.71 +/- 0.12 mg/dl, p = 0.005) and a greater number of infants with a urine Chemstrip positive for heme (14/35 vs 3/35, p = 0.005). No differences existed between groups in time to first void, urine specific gravity, and number of infants with microscopic hematuria.Conclusion: Term and near-term infants born with an umbilical artery pH less than or equal to 7.0 and triaged to the newborn nursery on the basis of a stable appearance in the delivery room do not have clinical manifestations of hypoxia-ischemia in the 48 hours after birth. The higher mean serum creatinine for acidemic compared with control groups is presumably prerenal in origin and results from processes responsible for profound fetal acidemia. Infants with an umbilical artery pH less than or equal to 7.0 and assessed to be clinically well can be treated similar to nonacidemic infants.