Vetr M
Gynekologicko-porodnická klinika FN, Olomouc.
Ceska Gynekol. 2010 Oct;75(5):447-54.
Analysis of the prevalence of neonatal adaptation after birth. Evaluation of indicators used and determining the levels of laboratory findings. Evaluation of benefits of commonly used indicators of the newborn condition in clinical practice.
Retrospective epidemiological study.
Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc.
Analysis of records of 18,208 live births in the ten-year period from 1.1.2000 to 31.12.2009--Inclusion criteria (complete data) fulfill 15 755 (86.5%) neonates.
In the whole set (n=15,755) the prevalence of pathological values of one-minute Apgar score (less than 7 points) was 5.4%, one per cent at 5 minutes and 0.2% at 10 minutes. Five-minute Apgar score of less than 4 points was in 23 (0.2%) newborns. Values below pH arterial cord blood under 7.00 (acidosis criterion ACOG) had 93 (0.6%) newborns. Analysis of lactate acidemia results relevant to a pH below 7.00 set lactate cutoff = 6.7 mmol/L (area under ROC curve 0.977). Prevalence findings lactate above 6.7 mmol/l is 7.2%. 93.5% of newborns in the group of newborns with a pH below 7.00 had a lactate above 6.7 mmol/l. In the whole set was moderate correlation of pH and lactate (r = -0.4318; 95% CI 0.4444 to -0.4190; P < 0.0001). Weak was the correlation of lactate and pH measurements to the clinical evaluation of the newborn. Comparing the two indicators of acidosis using method of "Gold standard" confirmed the higher sensitivity of lactate values above 6.7 mmol/l compared to pH < 7.00 in relation to very low values of Apgar at 5 minutes.
The results obtained confirm that acidemia after birth is relatively frequent, but not always echoed in the clinical condition of the newborn after birth. Assessing the diagnostic importance of lactate shows better results in relation to the clinical status of newborns and values above 6.7 mmol/l can be regarded as an important clinical indicator of neonatal acidosis. Determination of lactate levels is not an alternative for the examination of the newborns, but in combination with other indicators improve standard for evaluation of newborns.
分析出生后新生儿适应情况的患病率。评估所使用的指标并确定实验室检查结果水平。评估临床实践中常用的新生儿状况指标的益处。
回顾性流行病学研究。
帕拉茨基大学医学院及奥洛穆茨大学医院妇产科诊所。
分析2000年1月1日至2009年12月31日这十年间18208例活产记录——纳入标准（完整数据）涵盖15755例（86.5%）新生儿。
在整个队列（n = 15755）中，1分钟阿氏评分病理值（低于7分）的患病率为5.4%，5分钟时为1%，10分钟时为0.2%。23例（0.2%）新生儿5分钟阿氏评分为4分以下。脐动脉血pH值低于7.00（美国妇产科医师学会酸中毒标准）的新生儿有93例（0.6%）。分析与pH值低于7.00相关的乳酸血症结果，设定乳酸临界值 = 6.7 mmol/L（ROC曲线下面积为0.977）。乳酸高于6.7 mmol/l的患病率为7.2%。pH值低于7.00的新生儿组中，93.5%的新生儿乳酸高于6.7 mmol/l。在整个队列中，pH值与乳酸呈中度相关（r = -0.4318；95% CI为0.4444至 -0.4190；P < 0.0001）。乳酸和pH测量值与新生儿临床评估的相关性较弱。使用“金标准”方法比较两种酸中毒指标，证实与5分钟时极低的阿氏评分相比，乳酸值高于6.7 mmol/l相对于pH < 7.00具有更高的敏感性。
所获得的结果证实出生后酸血症相对常见，但出生后新生儿的临床状况并非总能反映这一点。评估乳酸的诊断重要性在新生儿临床状况方面显示出更好的结果，高于6.7 mmol/l的值可被视为新生儿酸中毒的重要临床指标。测定乳酸水平并非新生儿检查的替代方法，但与其他指标结合可改善新生儿评估标准。
