Casey B M, Goldaber K G, McIntire D D, Leveno K J
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032, USA.
Am J Obstet Gynecol. 2001 Feb;184(3):447-50. doi: 10.1067/mob.2001.109394.
This study was undertaken to measure infant outcomes when pH at birth was compared with neonatal pH determined within 2 hours of age.
We retrospectively studied term infants born between January 1, 1988, and August 31, 1998, who had umbilical artery blood pH measured at birth and again from the radial artery or umbilical artery within 2 hours after birth. Statistical significance was determined with the chi2 test. Odds ratios and 95% confidence intervals were calculated by means of the Mantel-Haenszel method.
Data from a total of 1691 infants were analyzed: 178 (11%) had acidemia at birth (pH of <7.20) that persisted through the first 2 hours after birth; 110 (6%) had development of acidemia after birth; and 594 (35%) were born with a cord pH of <7.20 that improved after delivery. The remaining 809 infants (48%) did not have acidemia either at birth or during the neonatal period, and these served as the reference group. Seizures during the first 24 hours after birth were more likely among those infants with persistent acidemia (odds ratio, 13.0; 95% confidence interval, 6.3-26.7). The odds ratio for seizures among infants in whom acidemia developed after birth was 5.7 (95% confidence interval, 2.2-14.5). Other than the reference group, the infants who were born with acidemia that was corrected by 2 hours after birth had the lowest risk of seizures (odds ratio, 2.5; 95% confidence interval, 1.2-5.3). Significant differences in neonatal outcomes persisted after correction for anomalies.
The direction of pH change from birth to the immediate neonatal period was significantly related to morbidity and mortality among term infants who were ill at birth or became ill shortly thereafter.
本研究旨在比较出生时的pH值与出生后2小时内测定的新生儿pH值时，测量婴儿的结局。
我们回顾性研究了1988年1月1日至1998年8月31日期间出生的足月儿，这些婴儿在出生时测量了脐动脉血pH值，并在出生后2小时内再次从桡动脉或脐动脉测量。采用卡方检验确定统计学显著性。通过Mantel-Haenszel方法计算比值比和95%置信区间。
共分析了1691例婴儿的数据：178例（11%）出生时患有酸血症（pH值<7.20），并持续至出生后的前2小时；110例（6%）出生后发生酸血症；594例（35%）出生时脐血pH值<7.20，出生后有所改善。其余809例婴儿（48%）在出生时或新生儿期均未患有酸血症，这些婴儿作为参照组。出生后24小时内，持续性酸血症的婴儿发生惊厥的可能性更大（比值比，13.0；95%置信区间，6.3 - 26.7）。出生后发生酸血症的婴儿惊厥的比值比为5.7（95%置信区间，2.2 - 14.5）。除参照组外，出生时患有酸血症但在出生后2小时内得到纠正的婴儿惊厥风险最低（比值比，2.5；95%置信区间，1.2 - 5.3）。校正异常情况后，新生儿结局仍存在显著差异。
从出生到新生儿早期pH值变化的方向与出生时患病或出生后不久患病的足月儿的发病率和死亡率显著相关。
