脐动脉血乳酸作为新生儿早期结局的预测指标及产时窒息的评估
Umbilical arterial blood lactate as predictor of early neonatal outcome and evaluation of intrapartum asphyxia.
作者信息
Badmus Olufemi M, Adenaya Olaide R, Aderinwale Oluseyi A, Ewuoso Bernard O, Awolaja Babatunde S, Ade-Onojobi Adedoyin O
机构信息
Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Ogun State, Nigeria.
出版信息
J Taibah Univ Med Sci. 2024 Sep 3;19(5):911-918. doi: 10.1016/j.jtumed.2024.08.027. eCollection 2024 Oct.
BACKGROUND
Perinatal asphyxia is a leading cause of under-5 mortality and exerts great pressure on the health system. Adequate foetal monitoring in labour is paramount in the early detection of foetal distress to prevent perinatal asphyxia. Several methods of foetal monitoring are in use with varying efficacy. This study investigated the efficacy of umbilical arterial (UA) lactate assay in predicting adverse perinatal outcomes.
METHODOLOGY
This was a prospective longitudinal study involving 160 pregnant women in the active phase of labour at term who met the inclusion criteria. They were recruited using a consecutive sampling technique and underwent a cardiotocography. Then they were classified into normal and abnormal cardiotocographic groups. At delivery, the UA blood of all of the babies was collected and assayed for serum lactate, and the levels were correlated with the perinatal outcome. The perinatal outcomes were measured by Apgar scores, admission into the neonatal unit, and hypoxic ischaemic encephalopathy. Analysis was done to determine the sensitivity and specificity of UA lactate in predicting birth asphyxia, hypoxic ischaemic encephalopathy, and neonatal unit admission.
RESULTS
The mean age ± standard deviation (SD) between the two cardiotocography (CTG) groups, normal years (30.55 ± 5.59) and abnormal years (29.86 ± 5.51), were similar. A critical UA lactate concentration > 9.1 mmol/L predicted Apgar scores < 7 at 5 min with a sensitivity and specificity of 76.47% (CI: 50.1-93.2) and 91.55% (CI: 85.7-95.6%), respectively. Also, the need for neonatal unit admission was predicted at a cut-off point >9.1 mmol/L with a sensitivity of 61.90% (CI: 38.4-81.9) and specificity of 91.30% (CI: 85.3-95.4). Umbilical artery lactate levels > 11.2 mmol/L predicted the development of hypoxic ischaemic encephalopathy in neonates with a sensitivity of 100% (CI: 39.8-100.0) and specificity of 88.39% (CI: 82.3-93.0).
CONCLUSION
Umbilical artery lactate correlates with adverse pregnancy outcomes and is an excellent tool for predicting adverse neonatal outcome.
背景
围产期窒息是5岁以下儿童死亡的主要原因，给卫生系统带来巨大压力。分娩时进行充分的胎儿监测对于早期发现胎儿窘迫以预防围产期窒息至关重要。目前有多种胎儿监测方法，其有效性各不相同。本研究调查了脐动脉（UA）乳酸测定在预测不良围产期结局方面的有效性。
方法
这是一项前瞻性纵向研究，纳入了160名足月分娩活跃期且符合纳入标准的孕妇。采用连续抽样技术招募她们，并进行了胎心监护。然后将她们分为胎心监护正常组和异常组。分娩时，采集所有婴儿的脐动脉血并检测血清乳酸水平，其水平与围产期结局相关。围产期结局通过阿氏评分、入住新生儿病房情况以及缺氧缺血性脑病来衡量。进行分析以确定脐动脉乳酸在预测出生窒息、缺氧缺血性脑病和入住新生儿病房方面的敏感性和特异性。
结果
两组胎心监护（CTG）组之间的平均年龄±标准差（SD）相似，正常组为（30.55±5.59）岁，异常组为（29.86±5.51）岁。脐动脉乳酸临界浓度>9.1 mmol/L预测5分钟时阿氏评分<7分，敏感性和特异性分别为76.47%（CI：50.1 - 93.2）和91.55%（CI：85.7 - 95.6%）。此外，脐动脉乳酸浓度>9.1 mmol/L时预测入住新生儿病房的敏感性为61.90%（CI：38.4 - 81.9），特异性为91.30%（CI：85.3 - 95.4）。脐动脉乳酸水平>11.2 mmol/L预测新生儿发生缺氧缺血性脑病的敏感性为100%（CI：39.8 - 100.0），特异性为88.39%（CI：82.3 - 93.0）。
结论
脐动脉乳酸与不良妊娠结局相关，是预测不良新生儿结局的优秀工具。
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