Fetal Medicine Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK.
Queen's University Medical School, Belfast, UK.
Int J Gynaecol Obstet. 2018 Jul;142(1):66-70. doi: 10.1002/ijgo.12502. Epub 2018 Apr 24.
To determine the importance of arterial pH and arterial base deficit (ABD) for predicting adverse outcomes among all term neonates, regardless of acidemic status.
The present observational cohort study included consecutive term, non-anomalous singleton neonates with validated paired cord gas data at a single UK teaching hospital between June 23, 2005, and December 31, 2009. Outcomes included encephalopathy (Sarnat grade 2-3) and/or death; 5-minute Apgar score below 7; a composite neurologic adverse outcome; and systemic involvement. Comparison of areas under the curve and hierarchical logistical regressions were used to examine the importance of arterial pH and arterial base deficit (ABD) in predicting adverse outcomes.
There were 8759 neonates included. In all, 111 (1.3%) neonates had high ABD (≥12 mmol/L). Encephalopathy and/or death was recorded in 17 (0.2%) neonates in the whole cohort and 6 (5.4%) from the high ABD group. The mean arterial pH values for these two groups were 7.23 and 7.03, respectively. Comparison of the area under the receiver operating characteristic curves showed that adding ABD to arterial pH did not improve the prediction. Further, hierarchical logistic regression analysis demonstrated that ABD was not an independent predictor of adverse outcomes when adjusted for arterial pH.
ABD demonstrated no predictive value for adverse neonatal outcomes beyond using arterial pH alone.
无论酸血症状态如何，确定动脉 pH 值和动脉碱剩余（ABD）对所有足月新生儿不良结局预测的重要性。
本观察性队列研究纳入了 2005 年 6 月 23 日至 2009 年 12 月 31 日期间在英国一所教学医院接受过经证实的配对脐带血气数据的连续足月、非畸形的单胎新生儿。结局包括脑病（Sarnat 分级 2-3）和/或死亡；5 分钟 Apgar 评分<7；复合神经不良结局；和全身受累。使用曲线下面积比较和分层逻辑回归来检验动脉 pH 值和动脉碱剩余（ABD）在预测不良结局中的重要性。
共纳入 8759 例新生儿。共有 111 例（1.3%）新生儿 ABD 较高（≥12mmol/L）。整个队列中有 17 例（0.2%）新生儿发生脑病和/或死亡，而高 ABD 组中有 6 例（5.4%）。两组的平均动脉 pH 值分别为 7.23 和 7.03。比较受试者工作特征曲线下面积表明，在考虑动脉 pH 值的基础上增加 ABD 并不能提高预测能力。此外，分层逻辑回归分析表明，当调整为动脉 pH 值时，ABD 不是不良结局的独立预测因子。
除单独使用动脉 pH 值外，ABD 对新生儿不良结局无预测价值。
