[Fetal acidemia and neonatal encephalopathy].

OBJECTIVE

The purpose of this study was to determine the significance of fetal acidemia for newborn encephalopathy (NEP) and for the combination of NEP and multiorgan system dysfunction (MOS). In particular the influence of acidemia will be contrasted with criteria of pregnancy and delivery.

STUDY DESIGN

248 infants delivered with cord umbilical arterial pH < 7.15 (UApH) were retrospectively studied. Infants with similar or identical neonatal characteristics formed different groups: unaffected neonatal development, NEP, NEMO (NEP combined with MOS), other diseases, infection, exitus letalis. Statistics and calculations were done by means of factor analysis, univariate analysis, Student-Newman-Keuls-test, and Chi 2-test (p < 0.05).

RESULTS

Twenty seven infants with UApH < 7.15 suffered from NEP. NEP in combination with MOS occurred in 11 cases. There was no relationship between the degree of acidemia and a single NEP. Infants with NEMO differ from all other groups in their mean UApH (p < 0.05). The Apgar scores 1 min and 5 min (A1, A5) separated newborns with unaffected neonatal development from all other groups (p < 0.05). UApH-differences in the group: NEMO resulted from a combination of acute intranatal fetal distress and operative delivery and a combination of A1, A5, preterm delivery, and pathologic CTG (p < 0.01).

CONCLUSIONS

The degree of acidemia impacts the occurrence of NEMO. However, UApH alone does not predict this combination of characteristics. The Apgar score should be taken into account to evaluate an acidemic UApH. In case of acidemia complex factors of pregnancy and delivery are associated with an increased risk of NEMO.