Association between umbilical cord artery pCO2 and the Apgar score; elevated levels of pCO2 may be beneficial for neonatal vitality after moderate acidemia

作者：Kro Grete A B^*; Yli Branka M; Rasmussen Svein; Noren Hakan; Amer Wahlin Isis; Rosen Karl G; Stray Pedersen Babill; Saugstad Ola D

来源：Acta Obstetricia et Gynecologica Scandinavica, 2013, 92(6): 662-670.

DOI：10.1111/aogs.12090

• Acidbase balance
• acidemia
• Apgar score
• intrapartum hypoxia
• newborn
• pH
• umbilical cord artery pCO2

Objective To determine the association between 5-min Apgar score and umbilical cord artery carbon dioxide tension (pCO2). Design Observational study. Setting European hospital labor wards. Population Data from 36432 newborns 36 gestational weeks were obtained from three sources: two trials of monitoring with fetal electrocardiogram (the Swedish randomized controlled trial and the European Union Fetal ECG trial) and Molndal Hospital data. After validation of the acidbase values, 25806 5-min Apgar scores were available for analysis. Methods Validation of the umbilical cord acidbase values was performed to obtain reliable data. 5-min Apgar score was regressed against cord artery pCO2 in a polynomial multilevel model. Main outcome measures Five-min Apgar score, umbilical cord pCO2, pH, and base deficit. Results Overall, a higher cord artery pCO2 was found to be associated with lower 5-min Apgar scores. However, among newborns with moderate acidemia, lower umbilical cord artery pCO2 (median pCO2 for the specific cord artery pH) was associated with lower 5-min Apgar scores, with a relative risk of 2.0 (95% confidence interval: 1.42.8) for 5-min Apgar scores 06. Conclusions Metabolic acidosis affects the newborn%26apos;s vitality more than respiratory acidosis. In addition, elevated levels of pCO2 may be beneficial for fetuses with moderate acidemia, and thus cord artery pCO2 is a factor that should be considered when assessing the compromised newborn.

• 出版日期2013-6