Abstract
Background: Perinatal asphyxia is accounting to 20% of neonatal mortalityin India. Cord lactate can be an alternative that is more readily available than cord pH and may help in early identification of birth asphyxia in resource limited settings. The aim of the current study is to correlate cord lactate levels with cord pH in term neonates with non-reassuring fetal heart status and thereby its use as a surrogate for cord pH. Subjects & Methods: Study design: Cross-sectional study. Setting: Neonatology unit at NRI general hospital, Chinakakani from August 2018 to July 2019. Study participants: All singleton term neonates delivered by assisted vaginal delivery or emergency caesarean section due to non-reassuring fetal heart status. Umbilical cord blood gas and lactate was obtained. Lactate was analysed by colorimetric method. Results: A total of 74 neonates were included. An analysis of cord pH & lactate, using correlation coefficient showed statistically significant p-values. Cord lactate was found to be statistically significant predictor for admission to NICU, post resuscitation care, invasive/noninvasive ventilation, and therapeutic hypothermia on multiple logistic regression analysis. Cord Lactate was found to have an Area under the curve (AUC) of 0.88 with no significant difference to cord pH on ROC curve analysis. Conclusion: Cord Lactate can be used as an objective test in predicting the neonates requiring NICU admission for morbidities related to fetal hypoxia similar to that of cord pH in term neonates.
Highlights
Birth asphyxia accounts for an estimated 9, 00,000 deaths each year and is one of the primary causes of early neonatal mortality. [1] The incidence of perinatal Asphyxia is 8.4% of all live births, and is accounting to 20% of neonatal mortality and 11% of under-5 mortality in India. [2,3]Fetal distress is described as an altered fetal physiology, leading to disruption of normal fetal oxygenation ranging from mild hypoxia to profound fetal asphyxia leading to metabolic acidosis, [4] causing permanent injury or death within a very short period
APGAR scoring at birth is a semi quantitative measurement with variable inter and intra observer reliability & cannot be used to describe birth asphyxia accurately.[6]. In this era of Pediatricians and Obstetricians being increasingly sued for Medico-legal negligence in cases of Birth asphyxia and developmental delay, there is a need for objective tests to substantiate fetal hypoxia
Cord pH and Base excess (BE) in blood gas analysis are established objective tests for assessment of fetal asphyxia and along with the clinical picture, it helps in making appropriate decisions about care after birth. [7,8] Low cord pH is substantially associated with neonatal mortality and morbidity and later cerebral palsy in childhoodbut requires immediate analysis, [9] and expensive equipment which may not be available near all delivery rooms
Summary
Birth asphyxia accounts for an estimated 9, 00,000 deaths each year and is one of the primary causes of early neonatal mortality. [1] The incidence of perinatal Asphyxia is 8.4% of all live births, and is accounting to 20% of neonatal mortality and 11% of under-5 mortality in India. [2,3]Fetal distress is described as an altered fetal physiology, leading to disruption of normal fetal oxygenation ranging from mild hypoxia to profound fetal asphyxia leading to metabolic acidosis, [4] causing permanent injury or death within a very short period. Cord pH and Base excess (BE) in blood gas analysis are established objective tests for assessment of fetal asphyxia and along with the clinical picture, it helps in making appropriate decisions about care after birth. Cord lactate can be an alternative to arterial blood gas and it may help in early identification of birth asphyxia in resource limited settings. Cord lactate can be an alternative that is more readily available than cord pH and may help in early identification of birth asphyxia in resource limited settings. Study participants: All singleton term neonates delivered by assisted vaginal delivery or emergency caesarean section due to non-reassuring fetal heart status. Conclusion: Cord Lactate can be used as an objective test in predicting the neonates requiring NICU admission for morbidities related to fetal hypoxia similar to that of cord pH in term neonates
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