Population-based reference curve for umbilical cord arterial ph in infants born at 28 to 42 weeks

Population-based reference curve for umbilical cord arterial ph in infants born at 28 to 42 weeks

Play all audios:

Loading...

ABSTRACT OBJECTIVE: The objective of the study was to examine normal variations of umbilical cord arterial pH by gestational age (GA). STUDY DESIGN: Population-based cohort study of 46 199


infants born from 2008 to 2014 in Stockholm, Sweden, with GA 28 to 42 weeks, Apgar score ⩾7 at 5 min, non-instrumental vaginal delivery, and birth weight for GA⩾3rd and ⩽97th percentile.


Quantile regression was used to investigate the associations between GA and infant sex, and pH. RESULTS: The mean umbilical cord arterial pH (s.d.) was 7.29 (0.10), 7.27 (0.07), 7.25 (0.07)


and 7.23 (0.07) among infants born at 28 to 31, 32 to 36, 37 to 41 and 42 weeks, respectively. Arterial pH decreased linearly with increasing GA, and female infants had higher pH than male


infants (_P_<0.001). CONCLUSION: Umbilical cord arterial pH varied in a linear fashion by GA and was influenced by infant sex. The provided reference curve taking GA into account may


yield a more accurate definition of acidosis at birth. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS


Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on


SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about


institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS MATERNAL PRE-PREGNANCY BODY MASS INDEX AND FOETAL ACIDOSIS IN VAGINAL AND


CAESAREAN DELIVERIES: THE JAPAN ENVIRONMENT AND CHILDREN’S STUDY Article Open access 23 February 2021 GESTATIONAL WEIGHT GAIN AND FOETAL ACIDOSIS IN VAGINAL AND CAESAREAN DELIVERIES: THE


JAPAN ENVIRONMENT AND CHILDREN’S STUDY Article Open access 23 November 2020 ASSOCIATION OF LABOUR DURATION IN SPONTANEOUS DELIVERIES WITH LOW NEONATAL APGAR SCORES AND FOETAL ACIDOSIS: THE


JAPAN ENVIRONMENT AND CHILDREN’S STUDY Article Open access 13 December 2022 REFERENCES * Armstrong L, Stenson BJ . Use of umbilical cord blood gas analysis in the assessment of the newborn.


_Arch Dis Child Fetal Neonatal Ed_ 2007; 92 (6): F430–F434. Article  CAS  Google Scholar  * Malin GL, Morris RK, Khan KS . Strength of association between umbilical cord pH and perinatal and


long term outcomes: systematic review and meta-analysis. _BMJ_ 2010; 340: c1471. Article  Google Scholar  * Yeh P, Emary K, Impey L . The relationship between umbilical cord arterial pH and


serious adverse neonatal outcome: analysis of 51,519 consecutive validated samples. _BJOG_ 2012; 119 (7): 824–831. Article  CAS  Google Scholar  * Thorp JA, Dildy GA, Yeomans ER, Meyer BA,


Parisi VM . Umbilical cord blood gas analysis at delivery. _Am J Obstet Gynecol_ 1996; 175 (3 Pt 1): 517–522. Article  CAS  Google Scholar  * Helwig JT, Parer JT, Kilpatrick SJ, Laros RK Jr.


. Umbilical cord blood acid-base state: what is normal? _Am J Obstet Gynecol_ 1996; 174 (6): 1807–1812; discussion 1812-1804. Article  CAS  Google Scholar  * Gilstrap LC 3rd, Leveno KJ,


Burris J, Williams ML, Little BB . Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. _Am J Obstet Gynecol_ 1989; 161 (3): 825–830. Article


  Google Scholar  * Hafstrom M, Ehnberg S, Blad S, Noren H, Renman C, Rosen KG _et al_. Developmental outcome at 6.5 years after acidosis in term newborns: a population-based study.


_Pediatrics_ 2012; 129 (6): e1501–e1507. Article  Google Scholar  * Kitlinski ML, Kallen K, Marsal K, Olofsson P . Gestational age-dependent reference values for pH in umbilical cord


arterial blood at term. _Obstet Gynecol_ 2003; 102 (2): 338–345. PubMed  Google Scholar  * Knutzen L, Svirko E, Impey L . The significance of base deficit in acidemic term neonates. _Am J


Obstet Gynecol_ 2015; 213 (3): 373 e371–373 e377. Article  Google Scholar  * White CR, Doherty DA, Kohan R, Newnham JP, Pennell CE . Evaluation of selection criteria for validating paired


umbilical cord blood gas samples: an observational study. _BJOG_ 2012; 119 (7): 857–865. Article  CAS  Google Scholar  * Marsal K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B .


Intrauterine growth curves based on ultrasonically estimated foetal weights. _Acta Paediatr_ 1996; 85 (7): 843–848. Article  CAS  Google Scholar  * Hankins GD, Speer M . Defining the


pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. _Obstet Gynecol_ 2003; 102 (3): 628–636. PubMed  Google Scholar  * Victory R, Penava D, Da Silva O, Natale R,


Richardson B . Umbilical cord pH and base excess values in relation to adverse outcome events for infants delivering at term. _Am J Obstet Gynecol_ 2004; 191 (6): 2021–2028. Article  CAS 


Google Scholar  * Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on


Neonatal Encephalopathy. _Obstet Gynecol_ 2014; 123 (4): 896–901. Article  Google Scholar  * Herbst A, Wolner-Hanssen P, Ingemarsson I . Risk factors for acidemia at birth. _Obstet Gynecol_


1997; 90 (1): 125–130. Article  CAS  Google Scholar  * Nicolaides KH, Economides DL, Soothill PW . Blood gases, pH, and lactate in appropriate- and small-for-gestational-age fetuses. _Am J


Obstet Gynecol_ 1989; 161 (4): 996–1001. Article  CAS  Google Scholar  * Wiberg N, Kallen K, Herbst A, Olofsson P . Relation between umbilical cord blood pH, base deficit, lactate, 5-minute


Apgar score and development of hypoxic ischemic encephalopathy. _Acta Obstet Gynecol Scand_ 2010; 89 (10): 1263–1269. Article  CAS  Google Scholar  * Wiberg N, Kallen K, Olofsson P .


Physiological development of a mixed metabolic and respiratory umbilical cord blood acidemia with advancing gestational age. _Early Hum Dev_ 2006; 82 (9): 583–589. Article  CAS  Google


Scholar  * Forhead AJ, Fowden AL . Thyroid hormones in fetal growth and prepartum maturation. _J Endocrinol_ 2014; 221 (3): R87–R103. Article  CAS  Google Scholar  * Fyfe KL, Yiallourou SR,


Wong FY, Horne RS . The development of cardiovascular and cerebral vascular control in preterm infants. _Sleep Med Rev_ 2014; 18 (4): 299–310. Article  Google Scholar  * Soothill PW,


Nicolaides KH, Rodeck CH, Campbell S . Effect of gestational age on fetal and intervillous blood gas and acid-base values in human pregnancy. _Fetal Ther_ 1986; 1 (4): 168–175. Article  CAS


  Google Scholar  * Gregg AR, Weiner CP . ‘Normal’ umbilical arterial and venous acid-base and blood gas values. _Clin Obstet Gynecol_ 1993; 36 (1): 24–32. Article  CAS  Google Scholar  *


Nava S, Bocconi L, Zuliani G, Kustermann A, Nicolini U . Aspects of fetal physiology from 18 to 37 weeks' gestation as assessed by blood sampling. _Obstet Gynecol_ 1996; 87 (6):


975–980. Article  CAS  Google Scholar  * Ramin SM, Gilstrap LC 3rd, Leveno KJ, Burris J, Little BB . Umbilical artery acid-base status in the preterm infant. _Obstet Gynecol_ 1989; 74 (2):


256–258. CAS  PubMed  Google Scholar  * Dickinson JE, Eriksen NL, Meyer BA, Parisi VM . The effect of preterm birth on umbilical cord blood gases. _Obstet Gynecol_ 1992; 79 (4): 575–578. CAS


  PubMed  Google Scholar  * Chanrachakul B, Chua S, Nordstrom L, Yam J, Arulkumaran S . Umbilical artery blood gas and lactate in healthy newborns. _J Med Assoc Thai_ 1999; 82 (4): 388–393.


CAS  PubMed  Google Scholar  * Rose J, Butler EE, Lamont LE, Barnes PD, Atlas SW, Stevenson DK . Neonatal brain structure on MRI and diffusion tensor imaging, sex, and neurodevelopment in


very-low-birthweight preterm children. _Dev Med Child Neurol_ 2009; 51 (7): 526–535. Article  Google Scholar  * Kent AL, Wright IM, Abdel-Latif ME . Mortality and adverse neurologic outcomes


are greater in preterm male infants. _Pediatrics_ 2012; 129 (1): 124–131. Article  Google Scholar  * Skiold B, Alexandrou G, Padilla N, Blennow M, Vollmer B, Aden U . Sex differences in


outcome and associations with neonatal brain morphology in extremely preterm children. _J Pediatr_ 2014; 164 (5): 1012–1018. Article  Google Scholar  * Clifton VL . Review: sex and the human


placenta: mediating differential strategies of fetal growth and survival. _Placenta_ 2010; 31 SUPPL: S33–S39. Article  CAS  Google Scholar  * Fellman V, Hellstrom-Westas L, Norman M,


Westgren M, Kallen K, Lagercrantz H _et al_. One-year survival of extremely preterm infants after active perinatal care in Sweden. _JAMA_ 2009; 301 (21): 2225–2233. Article  Google Scholar 


* Apgar V . A proposal for a new method of evaluation of the newborn infant. _Curr Res Anesth Analg_ 1953; 32 (4): 260–267. CAS  Google Scholar  * Wiberg N, Kallen K, Olofsson P . Delayed


umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. _BJOG_ 2008; 115 (6): 697–703. Article  CAS  Google Scholar  * Westgate J,


Garibaldi JM, Greene KR . Umbilical cord blood gas analysis at delivery: a time for quality data. _Br J Obstet Gynaecol_ 1994; 101 (12): 1054–1063. Article  CAS  Google Scholar  Download


references ACKNOWLEDGEMENTS Professor Sven Cnattingius initiated and conceptualized the research database, and is responsible for the database infrastructure. The work was supported by the


Stockholm County Council (ALF 20130156, 20140105, 20150118 and post-doctoral financial support); and the Swedish Research Council (2013–2429). The funders had no involvement in study design,


collection, analysis, and/or interpretation of data, writing of the report or the decision to submit the paper for publication. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of


Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden B Skiöld * Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden B Skiöld *


Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden G Petersson, M Ahlberg, O Stephansson & S Johansson * School of Public Health,


University of California, Berkeley, CA, USA O Stephansson * Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden S Johansson Authors * B Skiöld View author


publications You can also search for this author inPubMed Google Scholar * G Petersson View author publications You can also search for this author inPubMed Google Scholar * M Ahlberg View


author publications You can also search for this author inPubMed Google Scholar * O Stephansson View author publications You can also search for this author inPubMed Google Scholar * S


Johansson View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to S Johansson. ETHICS DECLARATIONS COMPETING INTERESTS The


authors declare no conflict of interest. ADDITIONAL INFORMATION Supplementary Information accompanies the paper on the _Journal of Perinatology_ website SUPPLEMENTARY INFORMATION


SUPPLEMENTARY TABLE 1 (DOCX 35 KB) SUPPLEMENTARY TABLE 2 (DOCX 60 KB) RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Skiöld, B., Petersson, G., Ahlberg,


M. _et al._ Population-based reference curve for umbilical cord arterial pH in infants born at 28 to 42 weeks. _J Perinatol_ 37, 254–259 (2017). https://doi.org/10.1038/jp.2016.207 Download


citation * Received: 28 April 2016 * Revised: 15 September 2016 * Accepted: 12 October 2016 * Published: 01 December 2016 * Issue Date: March 2017 * DOI: https://doi.org/10.1038/jp.2016.207


SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy


to clipboard Provided by the Springer Nature SharedIt content-sharing initiative