Sehdev H M, Stamilio D M, Macones G A, Graham E, Morgan M A
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, USA.
Am J Obstet Gynecol. 1997 Nov;177(5):1030-4. doi: 10.1016/s0002-9378(97)70008-5.
Fewer than 50% of neonates with an umbilical arterial pH < 7.00 have neonatal complications. Our objective was to identify clinical predictive factors for adverse outcomes in this group of neonates.
In this case-control study both cases and controls had an umbilical arterial cord pH < 7.00. Cases were defined as those neonates who had seizures, grade 3 to 4 intraventricular hemorrhage, gastrointestinal dysfunction, respiratory distress syndrome requiring intubation, sepsis, or death. Controls had an umbilical arterial cord pH < 7.00 and no complications. A multivariable prediction model was created, with variables having an association with adverse outcome by bivariate analyses, attempting to predict which neonates in this umbilical arterial pH range are at greatest risk for adverse outcomes.
We identified 73 of 10,705 neonates born between July 1992 and October 1996 with an umbilical arterial cord pH < 7.00. Thirty-five neonates met our case definition, and the remaining 38 composed the control group. Cases had significantly lower arterial pH values and 1- and 5-minute Apgar scores, greater arterial base deficit values, and a higher incidence of abruptio placentae and maternal cocaine use. More cases were delivered before 34 weeks. There were three neonatal deaths, two cases of grade 3 or 4 intraventricular hemorrhage, five cases of gastrointestinal dysfunction, and four cases of neonatal seizures. In our predictive model for adverse neonatal outcome, an arterial base deficit > or = 16 mmol/L and a 5-minute Apgar score < 7 had a sensitivity and a specificity of 79% and 80.8%, respectively.
Neonatal morbidity in neonates with an umbilical arterial cord pH < 7.00 can be predicted by a high arterial base deficit value and low 5-minute Apgar score.
脐动脉血pH值<7.00的新生儿中，发生新生儿并发症的比例不到50%。我们的目的是确定这组新生儿不良结局的临床预测因素。
在这项病例对照研究中，病例组和对照组的脐动脉血pH值均<7.00。病例定义为发生惊厥、3至4级脑室内出血、胃肠功能障碍、需要插管的呼吸窘迫综合征、败血症或死亡的新生儿。对照组的脐动脉血pH值<7.00且无并发症。通过多变量分析建立了一个预测模型，纳入双变量分析中与不良结局相关的变量，试图预测在此脐动脉血pH值范围内哪些新生儿发生不良结局的风险最高。
我们在1992年7月至1996年10月出生的10705例新生儿中，确定了73例脐动脉血pH值<7.00的新生儿。35例新生儿符合病例定义，其余38例组成对照组。病例组的动脉血pH值、1分钟和5分钟阿氏评分显著更低，动脉碱缺失值更高，胎盘早剥和母亲使用可卡因的发生率更高。更多病例在34周前分娩。有3例新生儿死亡，2例3至4级脑室内出血，5例胃肠功能障碍，4例新生儿惊厥。在我们的新生儿不良结局预测模型中，动脉碱缺失≥16 mmol/L和5分钟阿氏评分<7分预测不良结局的敏感性和特异性分别为79%和80.8%。
脐动脉血pH值<7.00的新生儿的发病情况可通过高动脉碱缺失值和低5分钟阿氏评分来预测。
