Apgar score and umbilical cord blood levels of Lactate and Creatinine in Perinatal asphyxia

Geetha Damodaran K,Gilsa E S,Parvathy R,Janaki Menon

doi:10.7439/ijbr.v6i4.1715

Geetha Damodaran K, Gilsa E S + Show 2 more

Open Access

https://doi.org/10.7439/ijbr.v6i4.1715

Copy DOI

Abstract

Objective: APGAR score and umbilical cord blood levels of Lactate and Creatinine in Perinatal asphyxia D esign: Descriptive cross sectional study. Setting: Labour room of Medical College Hospital, Thrissur , Kerala Subjects: 128 babies born during two months period (April May 2008 were included in the study. Outcome measures: Well being of the new born assessed by the clinical criterion, Apgar score and severity of asphyxia in the new born assessed by cord blood lactate and creatinine. Results: Reference limits and clinical decision limits of lactate (12- 76 mg%; 27mg %) and creatinine (0.60-1.4 mg%; 0.81 mg %) were found out. The clinical decision limit of lactate obtained in the study (27 mg %) was found to be significantly associated with perinatal asphyxia diagnosed by Apgar score. Sensitivity and specificity of cord blood lactate at the cut off value of 27 mg% is 68% and 60 % respectively (AUC = 0.679 P =0.0001) Where as for creatinine the clinical decision limit obtained was 0.81 and at this level +ve LR and -ve LR were 1.34 and 0.59 respectively. The area under ROC curve (AUC) was 0.576 but it did not the achieve statistical significance (P = 0.1336) Conclusion: Cord blood lactate assay of new born will help to evaluate the severity of anoxia and it will be useful to nullify any subjective errors produced during the clinical assessment of newborn babies by Apgar score.

Highlights

It is difficult to accurately assess the incidence of perinatal asphyxia because of non uniform clinical criteria on which different institutions base their definition
A low Apgar score may be related to factors other than perinatal asphyxia like gestational www.ssjournals.com
During the two months study period 128 new born babies were evaluated for perinatal asphyxia in terms of I minute Apgar score, cord blood lactate and creatinine

Summary

Introduction

It is difficult to accurately assess the incidence of perinatal asphyxia because of non uniform clinical criteria on which different institutions base their definition. The incidence of asphyxia varies between 1% and 5% depending on the criteria used in making the diagnosis.[1] There is no ideal measure to assess perinatal asphyxia in clinical practice. The commonly used Apgar score has been shown to be not specific for hypoxia and has a weak relationship with biochemical evidence of asphyxia.[2][3][4]. A low Apgar score may be related to factors other than perinatal asphyxia like gestational www.ssjournals.com. Geetha Damodaran K et al / APGAR score and umbilical cord blood levels of Lactate and Creatinine in Perinatal asphyxia 243 age, maternal medication and anesthetic administration. The study of Borruto et al[5] showed that evidence of clinical fetal distress is not related to severity of hypoxia

Methods

Results

Conclusion