Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score

Serafina Perrone,Desiree Sordino,Rita De Santis,Giuseppe De Bernardo,Giuseppe Buonocore,Maurizio Giordano

doi:10.1186/s13052-020-0786-8

Abstract

BackgroundNeonatal acidaemia at birth can increase neonatal morbidity and mortality and it is predictive of neonatal asphyxia. The umbilical blood gas analysis is a valid tool for the evaluation of neonatal acidaemia. However, umbilical cord blood gas analysis is commonly performed in high-risk situations or in the setting of Apgar scores < 7 at 5 min.MethodsA retrospective cohort study was conducted from June to December 2018 at the Department of mother’s and child’s health, Poliambulanza Foundation Hospital Institute. Inclusion criteria were: full term newborns with body weight appropriate for gestational age, born by vaginal delivery or caesarean section, reassuring Apgar Score > 7 at 5 min, arterial cord blood gas analysis showing pH < 7.4 or BE <-8 mmol/l or lactate > 6 mmol/l. The aim was to evaluate the predictive role of blood gas analysis for respiratory distress syndrome in newborns with reassuring Apgar Score.Results352 full term newborns were enrolled. Umbilical cord blood artery pH showed an association with respiratory distress syndrome (χ2(1) = 10,084, OR (95% CI): 3,9 × 10− 4(2,9 × 10− 6 - 0,048); p < 0,05). ROC curve revealed that the cut-off point of pH was 7.12, with a sensibility and specificity of 68 and 63%, respectively.ConclusionsUmbilical cord blood artery pH < 7.12 at birth is associated to respiratory distress syndrome in newborns. Blood gas analysis is an important instrument to help health care providers during assistance in the delivery room, but also to early identify newborns at high risk for respiratory distress syndrome and better manage the care of these newborns after birth.

Highlights

Neonatal acidaemia at birth can increase neonatal morbidity and mortality and it is predictive of neonatal asphyxia
Neonatal acidaemia is correlated with an increased risk of admission in neonatal intensive care unit (NICU), hypoxic ischemic encephalopathy, respiratory distress syndrome (RDS) [5, 6], multi-organ disfunction and neonatal exitus [7]
Umbilical cord Blood Gas Analysis (BGA) is generally required for Apgar Score < 7V and in newborns with a high risk of asphyxia

Summary

Introduction

Neonatal acidaemia at birth can increase neonatal morbidity and mortality and it is predictive of neonatal asphyxia. Umbilical cord blood gas analysis is commonly performed in high-risk situations or in the setting of Apgar scores < 7 at 5 min. Umbilical cord blood gas analysis is important to evaluate neonatal acidaemia during delivery. There are not clear threshold value of pH, BE and lactate It is not clear if newborns with moderate acidaemia and Apgar score ≥ 7V must be monitored for development of adverse outcome. Newborns with a good Apgar score have a residual risk of neonatal acidaemia and adverse outcomes [7]. Our study analysed BGA to understand if the umbilical blood acidaemia was predictive for RDS in newborns with reassuring Apgar Score > 7 at 5 min.

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Results

Discussion

Conclusion