THE EFFECT OF PROFOUND UMBILICAL ARTERY ACIDEMIA IN TERM NEONATES ADMITTED TO A NEWBORN NURSERY

Objective: To determine whether there were immediate adverse effects o f an umbilical artery pH less than or equal to 7.0 in term and near-te rm infants. Study design: All infants triaged to the newborn nursery w ith an umbilical artery pH less than or equal to 7.0 from May 1993 thr ough April 1994 (n = 37) were prospectively identified; 35 of the 37 i nfants were enrolled and matched with nonacidemic control infants (n = 35). Organ system dysfunction (neurologic, renal, hepatic, gastrointe stinal) was evaluated either clinically or biochemically with selected blood and urine parameters. Results: Acidemic and control groups were similar for pregnancy complications before labor, but acidemic infant s were more often delivered by cesarean section (20/35 vs 6/35, p = 0. 001). No differences existed between acidemic and control infants in g estational age, birth weight, neurologic evaluations, hearing deficits , feeding tolerance, and hepatic function. The acidemic group had a hi gher mean serum creatinine than control infants on day 2 of life (0.90 +/- 0.34 vs 0.71 +/- 0.12 mg/dl, p = 0.005) and a greater number of i nfants with a urine Chemstrip positive for heme (14/35 vs 3/35, p = 0. 005). No differences existed between groups in time to first void, uri ne specific gravity, and number of infants with microscopic hematuria. Conclusion: Term and near-term infants born with an umbilical artery pH less than or equal to 7.0 and triaged to the newborn nursery on the basis of a stable appearance in the delivery room do not have clinica l manifestations of hypoxia-ischemia in the 48 hours after birth. The higher mean serum creatinine for acidemic compared with control groups is presumably prerenal in origin and results from processes responsib le for profound fetal acidemia. Infants with an umbilical artery pH le ss than or equal to 7.0 and assessed to be clinically well can be trea ted similar to nonacidemic infants.