Dose-dependent relationship between acidosis at birth and likelihood of death or cerebral palsy
Open accessAbstract
Background: The acid-base status of infants around birth can provide information about their past, current and future condition. Although umbilical cord blood pH <7.0 or base deficit ≥12 mmol/L is associated with increased risk of adverse outcome, there is uncertainty about the prognostic value of degree of acidosis as previous studies have used different variables, thresholds, outcomes and populations. Methods: Retrospective review of routinely collected clinical data in all live-born inborn infants of 35 weeks gestation or more delivered between January 2005 and December 2013 at the Simpson Centre for Reproductive Health, Edinburgh, UK. Infants were included if their lowest recorded pH was <7 and/or highest base deficit ≥12 mmol/L on either umbilical cord blood and/or neonatal blood gas within 1 hour of birth. Neurodevelopmental outcome of the infants with encephalopathy was collected from the targeted follow-up database. Results: 56 574 infants were eligible. 506 infants (0.9%) met inclusion criteria. Poor condition at birth and all adverse outcomes increased with worsening acidosis. Combined outcome of death or cerebral palsy was 3%, 10% and 40% at lowest pH of 6.9–6.99, 6.8–6.89 and <6.8, respectively, and 8%, 14% and 59% at a base deficit of 12–15.9, 16–19.9 and 20 mmol/L or more, respectively. Conclusions: There is a dose-dependent relationship between the degree of acidosis within an hour of delivery, and the likelihood of adverse neonatal and later neurodevelopmental outcome in infants born at 35 weeks gestation or more.
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Only a single study has reported that the risk of adverse outcomes correlated with pH.
“At present, only a single study has reported that the risk of adverse outcomes correlated with pH.”
From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [15]
In that single study, the risk of adverse outcomes increased from 3% when pH 6.9-<7, to 10% and 40% when pH dropped to 6.8-<6.9 and <6.8, respectively.
“The risk of adverse outcomes increased from 3% when the pH was between 6.9 and <7, to 10% and 40% when the pH dropped to 6.8– <6.9 and <6.8, respectively.”
From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [15]
In that single study, 37 neonates (7.3%) did not have umbilical samples, and blood was taken from their bodies some time later.
“However, 37 neonates (7.3%) of their cohort did not have umbilical samples, and blood was only taken from their bodies some time later.”
From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [15]
Information on the prognostic factors of this group of babies is limited.
“Information on the prognostic factors of this group of babies is limited.”
From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [15]
The effect of other potential prognostic factors such as Apgar scores, mode of delivery, gestational age, SGA, implementation of neonatal hypothermic therapy, and presence of a known sentinel event was not assessed in that study.
“Second, the effect of other potential prognostic factors such as Apgar scores, mode of delivery, gestational age, small for gestational age (SGA), implementation of neonatal hypothermic therapy, and the presence of a known sentinel event was not assessed.”
From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [15]
Cites
Palisano, R. J., Rosenbaum, P., Walter, S. D., Russell, D., Wood, E. P., & Galuppi, B. E. (1997) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.1997.tb07414.x · Cited by 6,728 · see citing works
Neonatal Encephalopathy Following Fetal Distress
Sarnat, H. B. (1976) · Archives of Neurology · doi:10.1001/archneur.1976.00500100030012 · Cited by 2,691 · see citing works
Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study
Badawi, N. A., Kurinczuk, J. J., Keogh, J., Alessandri, L. M., O'Sullivan, F., Burton, P. R., Pemberton, P. J., & Stanley, F. J. (1998) · BMJ · doi:10.1136/bmj.317.7172.1549 · Cited by 891 · see citing works
MacLennan, A. (1999) · BMJ · doi:10.1136/bmj.319.7216.1054 · Cited by 731 · see citing works
Malin, G. L., Morris, R. K., & Khan, K. S. (2010) · BMJ · doi:10.1136/bmj.c1471 · Cited by 461 · see citing works
Threshold of metabolic acidosis associated with newborn complications
Low, J. A., Lindsay, B. G., & Derrick, E. J. (1997) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(97)70080-2 · Cited by 316 · see citing works
Yeh, P., Emary, K. R. W., & Impey, L. W. M. (2012) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2012.03335.x · Cited by 299 · see citing works
Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction
Gilstrap, L. C., Leveno, K. J., Burris, J., Williams, M. L., & Little, B. B. (1989) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(89)90410-9 · Cited by 243 · see citing works
ACOG Committee Opinion No. 348: Umbilical Cord Blood Gas and Acid-Base Analysis
(2006) · Obstetrics & Gynecology · doi:10.1097/00006250-200611000-00058 · Cited by 211 · see citing works
Neonatal complications at term as related to the degree of umbilical artery acidemia
Winkler, C. L., Hauth, J. C., Tucker, J. M., Owen, J., & Brumfield, C. G. (1991) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(11)80038-4 · Cited by 169 · see citing works
Perlman, J. M., & Risser, R. (1996) · PEDIATRICS · doi:10.1542/peds.97.4.456 · Cited by 145 · see citing works
Acid-base status at birth and neurodevelopmental outcome at four and one-half years
Dennis, J., Johnson, A., Mutch, L., Yudkin, P. L., & Johnson, P. (1989) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(89)90269-x · Cited by 139 · see citing works
Shankaran, S., Laptook, A. R., Tyson, J. E., Ehrenkranz, R. A., Bann, C., Das, A., Higgins, R. D., Bara, R., Pappas, A., McDonald, S. A., et al. (2011) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.09.018 · Cited by 139 · see citing works
UMBILICAL CORD BLOOD GAS ANALYSIS
Thorp, J. A., & Rushing, R. S. (1999) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/s0889-8545(05)70107-8 · Cited by 128 · see citing works
Basu, S. K., Kaiser, J. R., Guffey, D., Minard, C. G., Guillet, R., & Gunn, A. J. (2015) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2015-308733 · Cited by 124 · see citing works
Factors associated with motor and cognitive deficits in children after intrapartum fetal hypoxia
Low, J. A., Galbraith, R. S., Muir, D. W., Killen, H. L., Pater, E. A., & Karchmar, E. J. (1984) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(84)90742-7 · Cited by 117 · see citing works
Mir, I. N., Johnson-Welch, S. F., Nelson, D. B., Brown, L. S., Rosenfeld, C. R., & Chalak, L. F. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.09.072 · Cited by 112 · see citing works
Neonatal complications in newborns with an umbilical artery pH <7.00
van den Berg, P. P., Nelen, W. L. D. M., Jongsma, H. W., et al. (1996) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(96)70021-2 · Cited by 111 · see citing works
van der Zee, A. D. J., Eendenburg, M. E. C. B.-V., Fidler, V., et al. (1979) · Early Human Development · doi:10.1016/0378-3782(79)90003-3 · Cited by 106 · see citing works
Outcome after successful resuscitation of babies born with Apgar scores of 0 at both 1 and 5 minutes
Haddad, B., Mercer, B. M., Livingston, J., et al. (2000) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2000.104951 · Cited by 87 · see citing works
Umbilical cord blood gas analysis at delivery
Thorp, Dildy, G. A., Yeomans, Meyer, & Parisi (1996) · American Journal of Obstetrics and Gynecology · doi:10.1053/ob.1996.v175.a74401 · Cited by 87 · see citing works
Ingemarsson, I., Herbst, A., & Thorngren‐Jerneck, K. (1997) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1997.tb10934.x · Cited by 75 · see citing works
Depressed Apgar scores, acid-base status, and neurologic outcome
Socol, M. L., Garcia, P. M., & Riter, S. (1994) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(94)70092-3 · Cited by 67 · see citing works
Arterial or venous umbilical pH as a measure of neonatal morbidity?
Huisjes, H. J., & Aarnoudse, J. G. (1979) · Early Human Development · doi:10.1016/0378-3782(79)90004-5 · Cited by 62 · see citing works
Dijxhoorn, M. J., Visser, G. H. A., Huisjes, H. J., et al. (1985) · Early Human Development · doi:10.1016/0378-3782(85)90117-3 · Cited by 61 · see citing works
Clustering of perinatal markers of birth asphyxia and outcome at age five years
Yudkin, P., Johnson, A., Clover, L. M., & Murphy, K. W. (1994) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1994.tb11945.x · Cited by 51 · see citing works
Acid-base status at birth and subsequent neurosensory impairment in surviving 500 to 1000 gm infants
Gaudier, F. L., Goldenberg, R. L., Nelson, K. G., Peralta-Carcelén, M., Johnson, S. E., DuBard, M. B., Roth, T. Y., & Hauth, J. C. (1994) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(94)70383-3 · Cited by 49 · see citing works
Outcomes among term infants when two-hour postnatal pH is compared with pH at delivery
Casey, B. M., Goldaber, K. G., McIntire, D. D., et al. (2001) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2001.109394 · Cited by 38 · see citing works
Umbilical venous blood pH: a useful aid in the diagnosis of asphyxia at birth.
D'Souza, S. W., Black, P. M., Cadman, J., et al. (1983) · Archives of Disease in Childhood · doi:10.1136/adc.58.1.15 · Cited by 33 · see citing works
Luthy, D. A., Shy, K. K., STRICKLAND, D. M., Wilson, J., Bennett, F. C., Brown, Z. A., & Benedetti, T. J. (1987) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(87)80027-3 · Cited by 31 · see citing works
Perinatal risk factors for neonatal intracerebral hemorrhage in preterm infants
Ertan, A. K., Tanriverdi, H. A., Meier, M., et al. (2004) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2004.06.008 · Cited by 31 · see citing works
Wildschut, J., FERON, F. J. M., Hendriksen, J. G. M., et al. (2005) · Early Human Development · doi:10.1016/j.earlhumdev.2004.11.006 · Cited by 25 · see citing works
Umbilical cord blood gas analysis at delivery.
Loh, S. F., Woodworth, A., & Yeo, G. S. (1998) · PubMed · Cited by 24 · see citing works
The association between cord pH at birth and intellectual function in childhood
Svirko, E., Mellanby, J., & Impey, L. (2008) · Early Human Development · doi:10.1016/j.earlhumdev.2007.02.002 · Cited by 24 · see citing works
Tejani, N., & Verma, U. L. (1989) · PubMed · Cited by 24 · see citing works
Threshold of metabolic acidosis associated with neonatal encephalopathy in the term newborn
Wayenberg, J.-L. (2005) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767050500249916 · Cited by 23 · see citing works
Umbilical cord blood gases and mortality and morbidity in the very low birth weight infant.
Hibbard, J., Hibbard, M. C., & Mp, W. (1991) · PubMed · Cited by 18 · see citing works
Clinical evaluation of the fetus and neonate
Valentin, L., Ekman, G., Isberg, P., et al. (1993) · Archives of Gynecology and Obstetrics · doi:10.1007/bf02768736 · Cited by 16 · see citing works
Perin, B. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.06.030 · Cited by 15 · see citing works
Perinatal Factors and 2-Year Minor Neurodevelopmental Impairment in Low Birth Weight Infants
Spinillo, A., Fazzi, E. M., Orcesi, S., et al. (2009) · Biology of the Neonate · doi:10.1159/000244141 · Cited by 12 · see citing works
Silva, A. M., Cootauco, A., Aina-Mumuney, A. J., et al. (2008) · Journal of Perinatal Medicine · doi:10.1515/jpm.2008.023 · Cited by 8 · see citing works
de Dios, J. G., Benavent, M. M., & Marco, F. C. (2000) · Revista de Neurología · doi:10.33588/rn.3102.99321 · Cited by 7 · see citing works
Graham, E. M., Holcroft, C. J., & Blakemore, K. J. (2002) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/jmf.12.2.123.126 · Cited by 5 · see citing works
Wu, L., Thorngren‐Jerneck, K., & Ingemasson, I. (1998) · PubMed · Cited by 3 · see citing works
[Actual and prognostic value of the arterial navel-pH for the newborn infant (author's transl)].
Litschgi, M., Jj, B., & Glatthaar, E. (1974) · PubMed · Cited by 3 · see citing works
[Prognostic value of umbilical blood pH measurement in newborn infants at birth].
Jm, T., Varnier, C., & Faure, M. (1972) · PubMed · Cited by 3 · see citing works
[Perinatal umbilical artery pH and cerebral function disorders in twins starting school].
Schneider, R. J., & Tanner, R. (1985) · PubMed · Cited by 2 · see citing works
Krebsfrüherkennung und Krebsepidemiologie bei Frauen über 40 Jahre
Krafft, W., Fiedler, H., & Schirmer, A. (1993) · Archives of Gynecology and Obstetrics · doi:10.1007/bf02265919 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
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Wong, L., Kwan, A. H. W., Lau, S. L., Sin, W. T. A., & Leung, T. Y. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2021.06.077 · Cited by 43 · see citing works
Predictors of death or severe impairment in neonates with hypoxic-ischemic encephalopathy
Glass, H. C., Wood, T. R., Comstock, B. A., Numis, A. L., Bonifacio, S. L., Cornet, M.-C., Gonzalez, F. F., Morell, A., Kolnik, S. E., Li, Y., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.49188 · Cited by 37 · see citing works
Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse
Wong, L., Tse, W. T., Lai, C. Y., Hui, A. S. Y., Chaemsaithong, P., Sahota, D. S., Poon, L. C., & Leung, T. Y. (2021) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13985 · Cited by 26 · see citing works
Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7
Lau, S. L., Lok, Z. L. Z., Hui, S. Y. A., Fung, G. P. G., Lam, H. S., & Leung, T. Y. (2023) · Acta obstetricia et gynecologica Scandinavica · doi:10.1111/aogs.14494 · Cited by 23 · see citing works
- Authors
- Kelly, R., Ramaiah, S., Sheridan, H., Cruickshank, H., Rudnicka, M., Kissack, C., Becher, J.-C., & Stenson, B. J.
- Affiliations
- NHS Lothian (GB)
- Royal Victoria Infirmary (GB)
- Corresponding author
- Kelly, Rod
- Venue
- Archives of Disease in Childhood - Fetal and Neonatal Edition
- Publisher
- BMJ
- Published
- 2017-12-08
- Volume
- 103
- Issue
- 6
- Pages
- F567-F572
- ISSN
- 1359-2998 (ISSN-L)
- 1468-2052
- OpenAlex
- W2775158939
- Cited by
- 42
- References
- 48
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 8 · 2022: 5 · 2021: 4 · 2020: 6 · 2019: 7 · 2018: 1
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- Archives of Disease in Childhood Fetal & Neonatal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- neonatal acidosis, umbilical cord pH, base deficit, neonatal asphyxia, neonatal encephalopathy, cerebral palsy, neonatal mortality, neurodevelopmental outcomes, dose-response relationship, term and near-term infants, prognostic factors
- MeSH terms
- Acidosis, Blood Gas Analysis, Cerebral Palsy, Fetal Blood, United Kingdom, Humans, Hydrogen-Ion Concentration, Infant, Infant, Newborn, Intensive Care Units, Neonatal, Oxygen, Prognosis, Retrospective Studies, Survival Rate, Risk Assessment, Neurodevelopmental Disorders
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