Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine, the University of Alabama at Birmingham, Birmingham, AL.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, School of Medicine, the University of Alabama at Birmingham, Birmingham, AL.
Am J Obstet Gynecol MFM. 2021 Jan;3(1):100248. doi: 10.1016/j.ajogmf.2020.100248. Epub 2020 Oct 6.
The predictive value of acidemia at birth on long-term neurodevelopmental outcomes remains poorly understood, especially in preterm neonates.
This study aimed to assess the relationship between the umbilical artery acid-base status and major neurodevelopmental disability at an age of between 5 and 8 years among children born very prematurely.
We performed a secondary analysis of the data from a follow-up study of a prospective cohort of 457 children aged between 23 weeks and 31 weeks and 6 days from 1996 to 2001. Arterial cord gas parameters that were <10th percentile in the original cohort of 457 neonates (ie, pH of <7.1, base deficit of <-8.6 mEq/L, and a partial pressure of CO of >77 mm Hg) were considered abnormal. Sensitivity analyses considered alternative definitions for abnormal cord gases including a pH of <7.0 or base deficit of <-12 mEq/L. The primary outcome was a composite of major neurodevelopmental disability, including an intelligence quotient score of <70, cerebral palsy, blindness, deafness, abnormal balance, impaired cognition, dystonia, and seizure disorder. A logistic regression analysis was used to adjust for race and caregiver intelligence quotient score and, in an additional analysis, for gestational age.
A total of 259 of 261 maternal-infant dyads were evaluated at a mean child age of 6.8 years, with complete umbilical cord gas data for 228 of those. Infants with an abnormal pH and a base deficit (defined above) were over 4-fold more likely to have the composite disability and an intelligence quotient score of <70. These increased odds persisted after adjusting for age and caregiver intelligence quotient score, but when considering gestational age as well, none of the umbilical cord gas parameters significantly predicted the presence of the composite disability or an intelligence quotient score of <70. However, when using the stricter umbilical cord gas criteria (ie, pH of <7.0 and a base deficit of <-12 mEq/L), a base deficit of <-12 mEq/L was independently associated with both neurodevelopmental disability and an intelligence quotient score of <70.
When defined more strictly, abnormal umbilical cord gases, specifically a base deficit of <-12 mEq/L, are associated with an increased risk for major long-term neurodevelopmental disability and an intelligence quotient score of <70 in children born very prematurely.
出生时酸中毒对长期神经发育结局的预测价值仍知之甚少，尤其是在早产儿中。
本研究旨在评估 1996 年至 2001 年间出生的非常早产儿在 5 至 8 岁时脐动脉酸碱状态与主要神经发育障碍之间的关系。
我们对一项前瞻性队列研究的随访数据进行了二次分析，该研究纳入了 457 名胎龄为 23 周至 31 周零 6 天的婴儿。在原始 457 例新生儿队列中，动脉脐带血气参数<第 10 百分位数（即 pH<7.1、碱缺失<-8.6 mEq/L 和二氧化碳分压>77mmHg）被认为异常。敏感性分析考虑了异常脐带血气的替代定义，包括 pH<7.0 或碱缺失<-12 mEq/L。主要结局是主要神经发育障碍的复合结局，包括智商评分<70、脑瘫、失明、耳聋、平衡障碍、认知障碍、肌张力障碍和癫痫发作障碍。使用逻辑回归分析调整种族和照顾者智商评分，在另外的分析中还调整了胎龄。
共有 261 对母婴对子中的 259 对在平均 6.8 岁的儿童年龄时接受了评估，其中 228 对有完整的脐带血气数据。pH 和碱缺失异常（上述定义）的婴儿发生复合残疾和智商评分<70 的可能性是前者的 4 倍以上。这些增加的风险在调整年龄和照顾者智商评分后仍然存在，但当考虑胎龄时，脐带血气参数均与复合残疾或智商评分<70 无关。然而，当使用更严格的脐带血气标准（即 pH<7.0 和碱缺失<-12 mEq/L）时，碱缺失<-12 mEq/L 与神经发育障碍和智商评分<70 均独立相关。
当定义更严格时，异常的脐带血气，特别是碱缺失<-12 mEq/L，与非常早产儿发生主要长期神经发育障碍和智商评分<70 的风险增加相关。
