Ta. King et al., THE EFFECT OF PROFOUND UMBILICAL ARTERY ACIDEMIA IN TERM NEONATES ADMITTED TO A NEWBORN NURSERY, The Journal of pediatrics, 132(4), 1998, pp. 624-629
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.