MARKERS OF ACUTE AND CHRONIC ASPHYXIA IN INFANTS WITH MECONIUM-STAINED AMNIOTIC-FLUID

OBJECTIVE: Cord blood pH, lactate, hypoxanthine, and erythropoietin le vels have all been used as markers of either acute or chronic asphyxia . We sought to determine whether these index values were significantly different in infants with or without meconium-stained amniotic fluid. STUDY DESIGN: Fifty-six pregnant women in spontaneous labor at term w ere divided into two groups on the basis of the presence or absence of meconium-stained amniotic fluid. All meconium-stained fluid was centr ifuged, and the volume percentage of particulate matter (i.e., meconiu m) was recorded. Umbilical artery blood and mixed arterial and venous cord blood were obtained at each delivery. Lactate, hypoxanthine, and erythropoietin levels were measured. Statistical analysis included Stu dent t test and rank sum statistics where appropriate. Normal and Spea rman correlation coefficients were also used. RESULTS: There were no s ignificant differences in mean umbilical artery pH (7.26 +/- 0.06 vs 7 .25 +/- 0.10), lactate levels (32.8 +/- 10 mg/dl vs 30.4 +/- 14.2 mg/d l), and hypoxanthine levels (13.4 +/- 6.7 mu mol/L vs 14.0 +/- 6.0 mu mol/L) in newborns with meconium (n = 28) compared with controls (n = 28). Erythropoietin levels were significantly greater in newborns with meconium (median 39.5 mlU/ml vs 26.8 mlU/ml, p = 0.039). There was no correlation between the amount of particulate matter and any marker o f asphyxia. CONCLUSIONS: There was no correlation between markers of a cute asphyxia (i.e., umbilical artery blood pH, lactate, or hypoxanthi ne) and meconium. However, erythropoietin levels were significantly el evated in newborns with meconium-stained amniotic fluid. This latter m arker may better correlate with chronic asphyxia.