ABSTRACT
Introduction: Perinatal asphyxia has become the leadingcause of death for newborns. Since the parameters that arebeing routinely used as a predictor for perinatal asphyxia suchas thick meconium stained liquor, non-reassuring fetal heartpatterns, low Apgar scores, fetal or cord blood pH do notshow consistent correlation with fetal acidosis but nucleatedred blood cell counts in umbilical venous blood of neonateshas been reported as a possible marker of perinatal asphyxia.The number of nucleated red blood cells (nRBCs)/100 whiteblood cells is variable but is rarely greater than 10 in normalneonates. The aim of this study was to study the using ofnucleated red blood cells in umbilical cord blood of newbornsas an indicator for perinatal asphyxia.Material and methods: The study comprised of intramuralterm neonates with and without asphyxia. It was a casecontrol study conducted in the Department of Pediatrics incollaboration with Department of Obstetrics and Gynaecology,Rohilkhand Medical College and hospital, Bareilly fromNovember 2017 to October 2018. There were 50 asphyxiatednewborns and 50 healthy newborns in the study. The meanlevels of nRBCs in cord blood were significantly higher(p value<0.001) in the asphyxial group (54.06+-22.42) ascompared to control group (10.32+-5.86).Results: Nucleated red blood cells were found to be stronglyassociated with perinatal asphyxia. The mean values of cordblood nRBCs in cases were 54.06+-22.42 and in controlgroup were 10.32+-5.86. The p value being <0.001 which wasstatistically significant indicating the correlation.Conclusions: Therefore it was concluded that nucleated redblood cells in umbilical cord blood of newborns can be used asan effective test for prediction of perinatal asphyxia.
ABSTRACT
Objective: Our purpose was to evaluate the relationship between umbilical cord arterial blood lactate levels with acid base balance to the mode of delivery and short-term neonatal outcome in a large multiracial population delivering at term in University of Malaya Medical Centre. Materials and methods: Two thousand two hundred and twelve patients of more than 37 weeks of gestation with singleton, liveborn infants with no major anomalies delivering between January 2013 to December 2013 were analysed. Lactate was measured by using portable Lactate analyzer that requires 5 µml of blood and provides the result within 1 minute. The deliveries took place at the Department of Obstetrics and Gynaecology, University Malaya Medical Centre, Malaysia where umbilical cord blood sampling and blood gas analysis is a part of the routine assessment of all newborn. Results: Gestational age ranged from 37 to 43 weeks (mean 39.05 weeks). The highest mean arterial cord lactate values were noted among babies delivered instrumentally (4.87 mmol/L). Infants who had a normal vaginal delivery had the second highest levels (3.36 mmol/L), followed by infants delivered by emergency caesarean section (3.30mmol/L). The lowest lactate values were noted in deliveries by elective caesarean section (3.0mmol/L). Cord arterial lactate levels were significantly higher among infants born with low Apgar scores (7.02 mmol/L vs 4.6mmol/L, P < 0.001). High arterial cord lactate was a significant predictor of admission to Neonatal intensive care unit (NICU) was 6.0mmol/L. Receiver operator curve (ROC) analysis suggests that lactate and pH are virtually equivalent in their correlation with adverse neonatal outcome. Conclusion: Cord lactate levels are significantly related to the mode of delivery and is equivalent to cord arterial pH in predicting adverse neonatal outcomes, with similar efficacies; however, its simplicity, less sampling failure and low cost makes lactate analysis an interesting alternative in obstetric care.
ABSTRACT
OBJETIVOS: Determinar si el intervalo de nacimiento vía vaginal entre gemelos, se relaciona con un descenso de pH arterial/venoso de cordón umbilical del segundo gemelo respecto al primero, y establecer si el pH acidótico del primer gemelo predice la acidosis del segundo. MÉTODO: Estudio de cohortes retrospectivo en 77 pares de gemelos realizado en el Hospital de Getafe, España, en el periodo 2008-2013. Se relacionó el tiempo transcurrido entre el nacimiento de los gemelos con el resultado del pH de cordón y el exceso de bases. Estudiamos la correlación entre el tiempo transcurrido entre ambos nacimientos y la diferencia entre los valores de pH del primer y segundo gemelo, y la correlación con la diferencia de exceso de base. RESULTADOS: Hubo correlación lineal significativa entre el tiempo transcurrido entre el nacimiento de los gemelos y la diferencia de pH venoso del segundo gemelo respecto del primero (R=0,560; p=0,0001), así como con el pH arterial (R=0,502; p=0,0001). El pH <7,20 del primer gemelo se asoció con acidosis en el cordón del 2° gemelo (<7,20, p=0,000; <7,15, p=0,0001; <7,10, p=0,0001; <7,05, p=0,001; <7,00, p=0,0001). CONCLUSIONES: El pH del segundo gemelo siempre fue igual o menor que el del primer gemelo, hubo una correlación lineal entre el intervalo de nacimiento entre gemelos y el descenso del pH venoso y arterial del segundo gemelo respecto al primero. El pH acidótico del primer gemelo predice la acidosis del segundo.
OBJETIVOS: Determinate if the twin-to-twin vaginal delivery time interval, is related with a decline of the arterio-venous cord blood pH of the second twin regarding to the first twin, and to evaluate if the acidotic pH of first twin can predict the acidosis status of the second one. METHOD: A retrospective descriptive cohort study was performed at the Hospital of Getafe, Spain, in the period 2008-2013, with 77 pairs of twins that were registered and met the inclusion criteria. The twin-to-twin delivery time interval and the cord blood status results were registered. A statistical analysis was performed to study the relation of the twin-to-twin delivery time interval with the pH value differences between first and second twins, and with the base excess. RESULTS: A positive linear correlation between the twin-to-twin delivery time interval and the difference of venous pH of the second twin respect to the first one was found (R=0.560; p=0.0001), and also with the difference on arterial pH (R=0.502; p=0.0001). A pH value <7.20 of the first twin was associated with blood cord acidosis of the second twin (<7.20, p=0.000; <7.15, p=0.0001; <7.10, p=0.0001; <7.05, p=0,001; <7.00, p=0.0001). CONCLUSIONS: The second twin pH was equal to or less than the first twin pH in all cases. There is a linear relation between twin-to-twin delivery time interval and the decrease of the pH value of the second twin regarding to the first one. The acidosis of first twin could predict the acidosis status of the second twin.