Evaluation of the commonly used laboratory and clinical parameters of the newborn shortly after birth. Check thresholds acidemia, and in relation to the method of termination of pregnancy.
Retrospective epidemiological study.
Department of Obstetrics and Gynecology, University Hospital, Olomouc.
Of the 26,869 children born in the years 2000 to 2013 Inclusion criteria (complete clinical and laboratory findings after birth) fulfill 23,471 (87.4%) neonates. Methods for evaluation of newborns included Apgar score calculation and arterial umbilical cord blood pH and lactate analysis.
A total of 0.7% (157) of the neonates had severe acidosis pH below 7.00 arterial umbilical cord blood, its prevalence varies annually between 0.1 to 1.1%. Cutoff lactate in relation to pH < 7.00 was 6.3 mmol/l (n = 23 471, the sensitivity of 92.99%, specificity 92.15%, AUC = 0.972). For children of low weight < 2500 g the cutoff value is lower, 5.3 mmol/l (n = 2592, 89.66% sensitivity, specificity 91.10% AUC = 0.912). Suprathreshold lactate values was 8.4% (1977) newborns. Correlation of pH and lactate to Apgar evaluation is very low and in the range from 1 to 10 minutes gradually decreases. Worse Apgar evaluation in children of low birth weight do not correspond to laboratory findings acidosis, which is probably related to prematurity and lower energy reserves. Operating cesarean births in particular accounts for more than half of those with worse clinical findings Apgar and pH <7.00, but only 30% supratreshold lactate values. Also worse clinical evaluation after caesarean section is not in accordance with the laboratory findings. Vaginal surgery, especially forceps have a significant share of severe acidosis than cesarean, regardless of their frequency. Risk factor of forceps to pH less 7.00,OR = 9.28 (5.39 -15.77), P = 0.0000000, while caesarean to pH less 7,00 had OR = 1.52 (1.08 to 2.14), P = 0.01408156.
The results obtained confirm that acidosis after birth is quite common, although they may not have response on the clinical condition of the newborn after birth. Evaluation of Apgar is little objective for the detection of hypoxia during birth and is influenced by the immaturity of newborn and method of delivery. Lactate levels may contribute to an objective assessment of hypoxia during birth. Values above 6.3 mmol/l can be considered an important indicator of newborn acidosis and birth hypoxia.
评估出生后不久新生儿常用的实验室检查和临床参数。检查酸血症阈值，并探讨与终止妊娠方法的关系。
回顾性流行病学研究。
奥洛穆茨大学医院妇产科。
2000年至2013年间出生的26869名儿童中，符合纳入标准（出生后完整的临床和实验室检查结果）的有23471名（87.4%）新生儿。评估新生儿的方法包括计算阿氏评分以及分析动脉脐血pH值和乳酸水平。
共有0.7%（157名）新生儿存在严重酸中毒，动脉脐血pH值低于7.00，其患病率每年在0.1%至1.1%之间波动。与pH值<7.00相关的乳酸临界值为6.3 mmol/l（n = 23471，敏感性为92.99%，特异性为92.15%，AUC = 0.972）。对于体重<2500 g的儿童，临界值较低，为5.3 mmol/l（n = 2592，敏感性为89.66%，特异性为91.10%，AUC = 0.912）。乳酸值高于临界值的新生儿占8.4%（1977名）。pH值和乳酸水平与阿氏评分评估的相关性非常低，且在出生后1至10分钟逐渐降低。低出生体重儿童较差的阿氏评分与酸中毒的实验室检查结果不相符，这可能与早产和能量储备较低有关。尤其是剖宫产出生的儿童中，阿氏评分较差且pH值<7.00的情况占比超过一半，但乳酸值高于临界值的仅占30%。剖宫产术后较差的临床评估也与实验室检查结果不符。阴道助产手术，尤其是产钳助产，严重酸中毒的比例比剖宫产高，无论其使用频率如何。产钳助产导致pH值<7.00的风险因素，OR = 9.28（5.39 - 15.77），P = 0.0000000，而剖宫产导致pH值<7.00的OR = 1.52（1.08至2.14），P = 0.01408156。
所得结果证实出生后酸中毒相当常见，尽管可能对出生后新生儿临床状况无影响。阿氏评分对出生时缺氧的检测客观性较差，且受新生儿不成熟和分娩方式影响。乳酸水平有助于客观评估出生时的缺氧情况。高于6.3 mmol/l的值可被视为新生儿酸中毒和出生时缺氧的重要指标。
