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Lee, Shin, Choi, Lee, Yi, Yun, Chae, and Lim: Assessment of the Value of the Umbilical Cord Blood Gas Parameter as Indicator of the Neonatal Condition
Original Article

Perinatology 2018;29(1):8-12.

Published online: 19 March 2018

DOI: https://doi.org/10.14734/PN.2018.29.01.08

Assessment of the Value of the Umbilical Cord Blood Gas Parameter as Indicator of the Neonatal Condition

Jeong Min Lee, MD, Hoon Bum Shin, MD, Young Bae Choi, MD, Na Mi Lee, MD, PhD, Dae Yong Yi, MD, Sin Weon Yun, MD, PhD, Soo Ahn Chae, MD, PhD, In Seok Lim, MD, PhD

Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea

Correspondence to Na Mi Lee, MD, PhD Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: +82-2-6299-3181 Fax: +82-2-6264-2167 E-mail: piena81@caumc.or.kr

Received 26 July 201721 September 2017       Accepted 23 October 2017

Copyright © 2018 The Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Umbilical cord blood gas analysis has widely been used to objectively evaluate the medical condition of newborn. Because umbilical cord blood gas analysis enables an immediate assessment of the acid-base balance of the newborn, it is crucial to perform the umbilical cord blood gas analysis before arterial blood gas analysis has been performed. This study was designed to evaluate the umbilical cord pH as an indicator reflecting the general condition of the newborn and to analyze its correlation with Apgar score and newborn arterial blood gas analysis.

Methods

A retrospective study was conducted for 209 neonates born from January 2013 to December 2015 at Chung-Ang University Medical Center. Demographic data such as Apgar score, gestational age, birth weight, umbilical cord blood analysis, newborn arterial blood gas analysis, and need for resuscitation were collected retrospectively.

Results

In neonates with birth weight more than 2,500 g, Pearson correlation coefficient indicated there were statistically significant associations between 1-minute or 5-minute Apgar score and umbilical artery pH (r=0.35 and r=0.33 with P<0.05, respectively). Similar correlations were also noted in those with a gestational age of more than 37 weeks (r=0.45 and r=0.44 with P<0.05, respectively). In addition, the odd ratio of developing neonatal acidosis was much higher with neonates not resuscitated than those resuscitated (9.5 for pH, 19.5 for base excess).

Conclusion

Our study highlights the value of the umbilical artery pH and base excess as indicators of the neonatal condition.

Keywords: Apgar score, Blood gas analysis, Infant, Umbilical cord

REFERENCES

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Table 1.
Clinical Characteristics of the Patients
Characteristic Value
Gestational age (wks) 34.2±3.3
Birth weight (g) 2,203.3±694.1
Delivery type  
Vaginal delivery 114 (65.5)
Caesarean section 60 (34.5)
Apgar at 1 minute 7.0±1.6
<2,500 g 6.9±1.5
≥2,500 g 7.3±1.7
Apgar at 5 minutes 8.4±1.1
<2,500 g 8.3±1.1
≥2,500 g 8.7±1.2
pH of umbilical artery 7.28±0.77
<2,500 g 7.30±0.06
≥2,500 g 7.26±0.09
pH of umbilical vein 7.32±0.76
<2,500 g 7.33±0.07
≥2,500 g 7.30±0.09
pH of neonatal artery 7.34±0.11
Base excess of neonatal artery -4.80±3.45

Values are presented as mean±standard deviation or number (%).

Table 2.
Correlation between Umbilical Cord Blood Gas Analysis and Apgar Score according to Birth Weight
Birth weight Apgar score pH Umbilical artery HCO3- Base excess pH Umbilical vein HCO3- Base excess
<2,500 g (n=118) 1 minute r=0.02 (P=0.82) r=0.13 (P=0.13) r=0.12 (P=0.16) r=0.05 (P=0.56) r=0.97 (P=0.29) r=0.10 (P=0.24)
  5 minutes r=-0.10 (P=0.25) r=0.13 (P=0.13) r=0.08 (P=0.36) r=-0.8 (P=0.35) r=0.12 (P=0.18) r=0.09 (P=0.33)
≥2,500 g (n=56) 1 minutes r=0.35∗ (P<0.01) r=0.27∗ (P=0.04) r=0.35∗ (P<0.01) r=0.41∗ (P<0.01) r=0.08 (P=0.51) r=0.18 (P=0.17)
  5 minutes r=0.33∗ (P=0.01) r=0.21 (P=0.11) r=0.29∗ (P=0.02) r=0.40∗ (P<0.01) r=0.08 (P=0.53) r=0.18 (P=0.18)

∗ P<0.05.

Table 3.
Correlation between Umbilical Cord Blood Gas Analysis and Apgar Score according to Gestational Age
Birth weight Apgar score e pH Umbilical artery HCO3- Base excess pH Umbilical vein HCO3- Base excess
<37 weeks (n=131) 1 minute r=0.01 (P=0.99) r=0.09 (P=0.27) r=0.08 (P=0.34) r=0.02 (P=0.77) r=0.05 (P=0.55) r=0.05 (P=0.52)
  5 minutes r=-0.12 (P=0.14) r=0.11 (P=0.18) r=0.05 (P=0.54) r=-0.10 (P=0.21) r=0.08 (P=0.34) r=0.04 (P=0.62)
≥37 weeks (n=43) 1 minute r=0.45∗ (P<0.01) r=0.40∗ (P<0.01) r=0.48∗ (P<0.01) r=0.52∗ (P<0.01) r=0.13 (P=0.37) r=0.25 (P=0.10)
  5 minutes r=0.44∗ (P<0.01) r=0.27 (P=0.11) r=0.39∗ (P<0.01) r=0.51∗ (P<0.01) r=0.12 (P=0.42) r=0.23 (P=0.12)

∗ P<0.05.

Table 4.
A Study of OR between Umbilical Acidosis and Neonatal Acidosis depending on Neonatal Resuscitation
Umbilicla blood Resuscitation Mean±SD Χ2 P-value OR (95% CI)
Umbilical artery Yes (n=51)
  pH 7.29±0.08 0.13 0.17 0.96 (0.90-1.02)
  Base excess -3.2±3.2 0.09 0.77 0.96 (0.91-1.02)
  No (n=123)        
  pH 7.28±0.07 1.88 0.718 4.58 (0.43-49.24)
  Base excess -3.0±2.6 30 0.03 1.33 (0.76-2.35)
Umbilical vein Yes (n=51)
  pH 7.3±0.08 1.54 0.21 0.98 (0.97-1.01)
  Base excess -4.0±3.4 3.26 0.07 0.94 (0.87-1.01)
  No (n=123)        
  pH 7.32±0.07 4.6 0.03 9.5 (1.10-112.6)
  Base excess -3.6±3.6 8.84 0.003 19.5 (1.36-278.77)

Abbreviations: OR, odds ratio; SD, standard deviation; CI, confidence interval.

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