1. Association of umbilical cord blood gas values with mortality and severe neurologic injury in preterm neonates29 weeks' gestation: a national cohort study
- Author
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Prakesh S. Shah, Jon Barrett, Martine Claveau, Zenon Cieslak, Hala Makary, Luis Monterrosa, Rebecca Sherlock, Jie Yang, Sarah D. McDonald, Marc Beltempo, Jaideep Kanungo, Joseph Ting, Ayman Abou Mehrem, Jennifer Toye, Khalid Aziz, Carlos Fajardo, Jaya Bodani, Lannae Strueby, Mary Seshia, Deepak Louis, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Sajit Augustine, Kyong-Soon Lee, Eugene Ng, Brigitte Lemyre, Thierry Daboval, Faiza Khurshid, Victoria Bizgu, Keith Barrington, Anie Lapoint, Guillaume Ethier, Christine Drolet, Bruno Piedboeuf, Marie St-Hilaire, Valerie Bertelle, Edith Masse, Roderick Canning, Cecil Ojah, Julie Emberley, Jehier Afifi, Andrzej Kajetanowicz, Shoo K. Lee, Wendy Whittle, Michelle Morais, Leanne Dahlgren, Darine El-Chaar, Katherine Theriault, Annie Ouellet, Kimberly Butt, Stephen Wood, Amy Metcalfe, Candace O'Quinn, Christy Pylypjuk, Isabelle Boucoiran, Catherine Taillefer, Joan Crane, Haim Abenhaim, Graeme Smith, Karen Wou, Sue Chandra, Jagdeep Ubhi, George Carson, Michael Helewa, Ariadna Grigoriu, Rob Gratton, Cynthia Chan, James Andrews, Nir Melamed, Jason Burrows, Fatima Taboun, Lara Wesson, Erin MacLellan, Hayley Boss, and Vicky Allen
- Subjects
Infant, Newborn ,Obstetrics and Gynecology ,Infant ,Gestational Age ,Hydrogen-Ion Concentration ,Fetal Blood ,Umbilical Cord ,Cohort Studies ,Pregnancy ,Lactates ,Birth Weight ,Humans ,Female ,Retrospective Studies - Abstract
Umbilical cord arterial and venous blood gas values reflect the acid-base balance status of a newborn at birth. Derangement in these values has been linked to poor neonatal outcomes in term and late preterm neonates; however, the utility of these values in preterm neonates of29 weeks' gestation is unclear.This study aimed to determine the associations of umbilical cord arterial and venous blood gas values with neonatal mortality and severe neurologic injury in extremely preterm neonates and to identify the cutoff values associated with 2.5-fold increases or decreases in the posttest probabilities of outcomes.This was a retrospective cohort study of neonates who were born at 23+0 to 28+6 weeks' gestation between January 1, 2018 and December 31, 2019, and who were admitted to neonatal units in Canada.Various cut-offs of umbilical cord blood gas values and lactate values were studied.The main outcomes were mortality before discharge from the neonatal unit and severe neurologic injury defined as grade 3 or 4 periventricular or intraventricular hemorrhage or periventricular leukomalacia. The outcome rates were calculated for various cutoff values of umbilical cord blood gas parameters and were adjusted for birthweight, gestational age, sex, and multiple births. Likelihood ratios were calculated to derive posttest probabilities.A total of 1040 and 1217 neonates had analyzable umbilical cord arterial and venous blood gas values, respectively. In the cohort, the mean (standard deviation) gestational age was 26.5 (1.5) weeks, the mean birthweight was 936 (215) g, the prevalence of mortality was 10% (105/1040), and the prevalence of severe neurologic injury was 9% (92/1016). An umbilical cord arterial pH of ≤7.1 and base excess of ≤-12 mmol/L were associated with2.5-fold higher posttest probability of mortality, and an umbilical cord arterial or venous lactate value of3 was associated with a 2.5-fold lower posttest probability of mortality. An umbilical cord arterial lactate value of3 was associated with a lower posttest probability of severe neurological injury.In preterm neonates of29 weeks' gestation, low umbilical cord arterial pH and high umbilical cord arterial base excess values were associated with a clinically important increase in the posttest probability of mortality, whereas low umbilical cord arterial or venous lactate values were associated with a decrease in the posttest probability of mortality.
- Published
- 2021