511: Neonatal acidemia in neonates with 5-minute apgar scores greater than 7 – What are the outcomes?

Abstract

ObjectiveIt is common to assess neonatal cord gases in the setting of an Apgar score of 6 or less. However, cases of neonatal acidemia may be missed with such an approach. In a setting of universal umbilical cord gases, we sought to ascertain the rates of neonatal acidemia, factors associated with increased risk, and outcomes associated with neonatal acidemia in neonates with 5-minute Apgar scores >7.Study DesignA retrospective cohort of all term, singleton, neonates with a 5-minute Apgar score>7 was designed. The incidence of umbilical artery pH<7.0, pH<7.1, base excess<-10, and base excess<-12 were examined overall and in association with several obstetric complications. Adverse neonatal outcomes were examined by the various acidemia groups as well. Chi-squared tests were utilized to compare proportions and potential confounders were controlled for using multivariable logistic regression.ResultsIn neonates with Apgar scores 7 or greater the overall incidence of an umbilical artery pH < 7.0 was 0.5%, pH<7.1 was 3.4%, base excess <-10 was 4.0%, and base excess <-12 was 1.4%. The rates of neonatal academia were greater in the setting of meconium, abruption, and cesarean delivery despite the normal 5-minute Apgar scores (Table 1, base excess data not shown). Additionally, pH<7 and pH<7.1 were associated with RDS, MAS, and NICU admissions. Base excess <-10 and -12 were associated with these outcomes plus neonatal sepsis.(Table 2)ConclusionView Large Image Figure ViewerDownload Hi-res image Download (PPT) ObjectiveIt is common to assess neonatal cord gases in the setting of an Apgar score of 6 or less. However, cases of neonatal acidemia may be missed with such an approach. In a setting of universal umbilical cord gases, we sought to ascertain the rates of neonatal acidemia, factors associated with increased risk, and outcomes associated with neonatal acidemia in neonates with 5-minute Apgar scores >7. It is common to assess neonatal cord gases in the setting of an Apgar score of 6 or less. However, cases of neonatal acidemia may be missed with such an approach. In a setting of universal umbilical cord gases, we sought to ascertain the rates of neonatal acidemia, factors associated with increased risk, and outcomes associated with neonatal acidemia in neonates with 5-minute Apgar scores >7. Study DesignA retrospective cohort of all term, singleton, neonates with a 5-minute Apgar score>7 was designed. The incidence of umbilical artery pH<7.0, pH<7.1, base excess<-10, and base excess<-12 were examined overall and in association with several obstetric complications. Adverse neonatal outcomes were examined by the various acidemia groups as well. Chi-squared tests were utilized to compare proportions and potential confounders were controlled for using multivariable logistic regression. A retrospective cohort of all term, singleton, neonates with a 5-minute Apgar score>7 was designed. The incidence of umbilical artery pH<7.0, pH<7.1, base excess<-10, and base excess<-12 were examined overall and in association with several obstetric complications. Adverse neonatal outcomes were examined by the various acidemia groups as well. Chi-squared tests were utilized to compare proportions and potential confounders were controlled for using multivariable logistic regression. ResultsIn neonates with Apgar scores 7 or greater the overall incidence of an umbilical artery pH < 7.0 was 0.5%, pH<7.1 was 3.4%, base excess <-10 was 4.0%, and base excess <-12 was 1.4%. The rates of neonatal academia were greater in the setting of meconium, abruption, and cesarean delivery despite the normal 5-minute Apgar scores (Table 1, base excess data not shown). Additionally, pH<7 and pH<7.1 were associated with RDS, MAS, and NICU admissions. Base excess <-10 and -12 were associated with these outcomes plus neonatal sepsis.(Table 2) In neonates with Apgar scores 7 or greater the overall incidence of an umbilical artery pH < 7.0 was 0.5%, pH<7.1 was 3.4%, base excess <-10 was 4.0%, and base excess <-12 was 1.4%. The rates of neonatal academia were greater in the setting of meconium, abruption, and cesarean delivery despite the normal 5-minute Apgar scores (Table 1, base excess data not shown). Additionally, pH<7 and pH<7.1 were associated with RDS, MAS, and NICU admissions. Base excess <-10 and -12 were associated with these outcomes plus neonatal sepsis.(Table 2) Conclusion