Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term.
Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term.
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DOI：
10.1097/aog.0000000000000466
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发表时间：
2014-10
影响因子：
7.2
通讯作者：
Cahill AG
中科院分区：
文献类型：
--
作者：
Tuuli MG;Stout MJ;Shanks A;Odibo AO;Macones GA;Cahill AG
检验脐带动脉乳酸优于 pH 值来预测足月新生儿短期发病率的假设。我们对 2009 年至 2012 年华盛顿大学医学中心的所有连续、非异常、单胎、头顶、足月分娩进行了前瞻性队列研究。在了解新生儿结局之前，在分娩后立即测量脐动脉乳酸和 pH 值。主要结局是新生儿复合发病率，包括新生儿死亡、插管、机械通气、胎粪吸入综合征、缺氧性脑病和需要低温治疗。使用接受者操作特征曲线比较乳酸和 pH 值的预测能力。根据最大约登指数估计乳酸和 pH 值的最佳截止值。在研究期间的 4,997 例足月分娩中，有 4,910 例符合纳入标准。 56 名新生儿（1.1%）发生了新生儿综合发病率。具有复合发病率的新生儿的平均乳酸水平几乎高出两倍（6.49 vs 3.26 mmol/L，p<0.001），而平均 pH 值则不太明显（7.19 vs 7.29，p<0.001）。乳酸比 pH 值更能预测新生儿发病率（ROC 曲线面积：0.84 vs 0.78，p=0.03）。预测新生儿发病率的最佳截止值为乳酸 3.90 mmol/L，pH 7.25。乳酸的相应敏感性和特异性也较高（分别为 83.9% 和 74.1% vs 75.0% 和 70.6%）。这项大型前瞻性队列研究的结果表明，与 pH 值相比，脐带动脉乳酸是衡量足月新生儿发病率更具辨别力的指标。
To test the hypothesis that umbilical cord arterial lactate is superior to pH for predicting short-term neonatal morbidity at term. We conducted a prospective cohort study of all consecutive, nonanomalous, singleton, vertex, term births from 2009 to 2012 at Washington University Medical Center. Umbilical arterial lactate and pH were measured immediately after delivery, prior to knowledge of neonatal outcomes. The primary outcome was a composite neonatal morbidity consisting of neonatal death, intubation, mechanical ventilation, meconium aspiration syndrome, hypoxic encephalopathy, and need for hypothermic therapy. The predictive ability of lactate and pH were compared using receiver-operating characteristics curves. Optimal cut-off values of lactate and pH were estimated based on the maximal Youden index. Of 4,997 term deliveries during the study period, 4,910 met inclusion criteria. The composite neonatal morbidity occurred in 56 neonates (1.1%). The mean lactate level was nearly two-fold higher in neonates with the composite morbidity (6.49 vs 3.26 mmol/L, p<0.001), while mean pH values were less distinct (7.19 vs 7.29, p<0.001). Lactate was significantly more predictive of neonatal morbidity than pH (ROC curve area: 0.84 vs 0.78, p=0.03). The optimal cut-off value for prediciting neonatal morbidity was 3.90 mmol/L for lactate and 7.25 for pH. Corresponding sensitivities and specificities were also higher for lactate (83.9% and 74.1% vs 75.0% and 70.6%, respectively). Results of this large prospective cohort study show that umbilical cord arterial lactate is a more discriminating measure of neonatal morbidity at term than pH.