Neonatal Outcome in High Risk Pregnancies Based on Umbilical Arterial Blood Gas Analysis

Abstract

The purpose of this study is to evaluate the correlation between umbilical arterial blood gas and short term outcome of the neonates born. This prospective observational cohort study was carried out at Department of Paediatrics, MLB Medical College, Jhansi on 120 term neonates delivered by caesarean sections or normal vaginal delivery of high risk mother based on Neonatal Resuscitation Program (NRP) between July 2017 to July 2018. All neonates were divided into two groups: 1) Group I (52 cases) consists of neonates with umbilical cord pH less than 7.2, whereas Group II (68 cases) consists of neonates with umbilical cord pH more than 7.2. Male babies and LSCS delivery were higher in both groups. The most common risk factors in mother are anemia (26%) and MSL (23%). All the cases were full term babies and have normal birth weight. Mean PO2 level was 11±6 and in group II it was 14±8. Mean PCO2 in group I was 63.7±13.7 while in group II it was 52.1±7.9. Mean bicarbonate was 21.36±3.54 and in group II it was found to be 24.13±3.25. On statistical analysis difference between pH, PCO2, PO2, BE and bicarbonate was significant. In group I, neonates required resuscitation in 57.69% (30 out of 52 cases), but in group II, only (10.29) (7 out of 68) cases required resuscitation. In group I, 48.07% (25 of 52) newborns were admitted to the NICU, whereas 5.88% (4 of 68) neonates in group II were admitted to the NICU. Encephalopathy is observed in 15 instances (28.85%) in Group I, but only 4 cases (5.88%) in Group II. HIE symptoms were frequently seen in the initial hours or days following delivery. Convulsion occurred in 11 instances (21.15.0%) in Group I, but only 3 cases (4.41%) in Group II. Convulsive disorders as sign of moderate encephalopathy had been presented more in neonates who had acidosis in 24 to 48 hours after birth. In group I, 26 cases (50.0%) had delayed in attaining oral feed until an hour, but in group II, only 4 cases (5.88%) cases had delay in attaining oral feed until an hour. The statistical association between delayed attainment of full meal and infant pH is significant. HIE is significantly higher in group 1. The average hospitals stay among academic newborns in Group I was 3.9613.199 days. The length of hospital stray in academic newborns exhibited an inverse connection with umbilical cord pH. In group II, the average length of hospital stay is 2.151.479 days. When compared to group II, group I experienced a considerably longer hospital stay. At 1 and 5 minutes of birth, a new-born with cord blood pH <7.2 had an APGAR score of 5.60±1.963 and 7.88±1.437, whereas a baby with cord blood pH >7.2 had an APGAR score of 8.70±0.964 and 8.70±0.964. According to statistical study, the APGAR score is significantly related to the pH of the cord blood. Umbilical cord blood ABG has been conducted as a definitive factor for fetus evaluation. The pH of umbilical cord blood is the best current criteria for diagnosing foetal hypoxemia during labour and determining appropriate postnatal care decisions.