Laboratory and clinical indicators of the state of the newborn after birth


Authors: M. Větr
Authors‘ workplace: Gynekologicko-porodnická klinika FN, Olomouc, přednosta doc. MUDr. Radovan Pilka, Ph. D.
Published in: Čes. Gynek.2010, 75, č. 5 s. 447-454

Overview

Objectives:
Analysis of the prevalence of neonatal adaptation after birth. Evaluation of indicators used and determining the levels of laboratory findings. Evaluation of benefits of commonly used indicators of the newborn condition in clinical practice.

Design:
Retrospective epidemiological study.

Setting:
Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc.

Methods:
Analysis of records of 18,208 live births in the ten-year period from 1. 1. 2000 to 31 12. 2009 - Inclusion criteria (complete data) fulfill 15 755 (86.5%) neonates.

Results:
In the whole set (n = 15 755) the prevalence of pathological values of one-minute Apgar score (less than 7 points) was 5.4%, one per cent at 5 minutes and 0.2% at 10 minutes. Five-minute Apgar score of less than 4 points was in 23 (0.2%) newborns. Values below pH arterial cord blood under 7.00 (acidosis criterion ACOG) had 93 (0.6%) newborns.

Analysis of lactate acidemia results relevant to a pH below 7.00 set lactate cutoff = 6.7 mmol / L (area under ROC curve 0.977). Prevalence findings lactate above 6.7 mmol / l is 7.2%. 93.5% of newborns in the group of newborns with a pH below 7.00 had a lactate above 6.7 mmol / l. In the whole set was moderate correlation of pH and lactate (r = -0,4318; 95% CI 0,4444 to –0,4190; P < 0,0001). Weak was the correlation of lactate and pH mesurements to the clinical evaluation of the newborn. Comparing the two indicators of acidosis using method of „Gold standard“ confirmed the higher sensitivity of lactate values above 6.7 mmol / l compared to pH <7.00 in relation to very low values of Apgar at 5 minutes.

Conclusion:
The results obtained confirm that acidemia after birth is relatively frequent, but not always echoed in the clinical condition of the newborn after birth. Assessing the diagnostic importance of lactate shows better results in relation to the clinical status of newborns and values above 6.7 mmol / l can be regarded as an important clinical indicator of neonatal acidosis. Determination of lactate levels is not an alternative for the examination of the newborns, but in combination with other indicators improve standard for evaluation of newborns.

Key words:
Apgar score, umbilical arterial pH, lactate, comparison.


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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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