Relation between umbilical cord blood pH, base deficit, lactate, 5-minute Apgar score and development of hypoxic ischemic encephalopathy
Relation between umbilical cord blood pH, base deficit, lactate, 5-minute Apgar score and development of hypoxic ischemic encephalopathy
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DOI：
10.3109/00016349.2010.513426
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发表时间：
2010-10-01
影响因子：
4.3
通讯作者：
Olofsson, Per
中科院分区：
文献类型：
--
作者：
Wiberg, Nana;Kallen, Karin;Olofsson, Per
客观的。脐带酸碱分析是评估产时缺氧的基础。评估了动脉脐带血乳酸、pH 和碱缺乏反映低 5 分钟阿普加评分和缺氧缺血性脑病 (HIE) 2-3 期的准确性，并将新的胎龄调整参考标准与传统的固定参考值进行了比较。设计和样品。使用接受者操作特征曲线和曲线下面积计算，对来自单胎分娩的总共 13,735 个经 pH 值验证的常规脐带酸碱值进行测试，并使用静态和孕龄调整参考值。环境。大学医院。主要成果衡量标准。低 pH、高碱缺乏和高乳酸（单独或组合）的准确性意味着 5 分钟阿普加评分 < 7 或 < 4 或 HIE。结果。所有参数的胎龄调整值均显着优于粗值，表明 Apgar 评分 < 7。对于 Apgar 评分 < 4，差异不显着。 HIE 的频率为 0.046%，使得统计分析毫无意义。胎龄调整乳酸在各种组合中总体准确度最高；低年龄调整的 pH 值加上高年龄调整的乳酸比低年龄调整的 pH 值加上高年龄调整的碱赤字稍好。所有参数的敏感性和阳性预测值均较低。结论。出生时脐带动脉血中的乳酸至少与碱不足一样好，以反映出生时受损的状况，并且在使用胎龄调整值时效果最好。由于碱缺乏计算中涉及的方法学混杂，乳酸可能会取代碱缺乏作为出生时的酸碱结果参数。
Objective. Umbilical cord acid-base analysis is fundamental for assessing intrapartum hypoxia. The accuracy of arterial umbilical cord blood lactate, pH and base deficit to reflect a low 5-minute Apgar score and hypoxic ischemic encephalopathy (HIE) stage 2-3 was assessed, and new gestational age-adjusted reference standards were compared with traditional stationary reference values. Design and sample. A total of 13,735 pH-validated routine cord acid-base values from singleton deliveries were tested with stationary and gestational age-adjusted reference values using receiver operating characteristic curves and calculation of area under curve. Setting. University hospital. Main outcome measures. Accuracy of low pH, high base deficit and high lactate, alone or in combination, to imply 5-minute Apgar score < 7 or < 4 or HIE. Results. Gestational age-adjusted values were for all parameters significantly better than crude values to indicate Apgar score < 7. For Apgar score < 4, the differences were not significant. The frequency of HIE was 0.046%, making statistical analyses pointless. Gestational age-adjusted lactate had the overall best accuracy and among combinations; a low age-adjusted pH plus high age-adjusted lactate was slightly better than a low age-adjusted pH plus high age-adjusted base deficit. The sensitivity and positive predictive value were low for all parameters. Conclusions. Lactate in cord arterial blood at birth is at least as good as base deficit to reflect an impaired condition at birth, and best when gestational age-adjusted values are used. Due to methodological confounding involved in calculation of base deficit, lactate may replace base deficit as an acid-base outcome parameter at birth.