Scribd
Upload
318 views2 pages

Umbilical Cord Blood Gas Analysis Guide

This document discusses umbilical cord blood gas analysis, which provides an objective assessment of a newborn's metabolic condition at birth. Elevated base deficit levels in cord blood can indicate perinatal hypoxia or asphyxia, which are potential causes of conditions like cerebral palsy. Cord blood gases should be analyzed in high-risk pregnancies or when abnormal fetal heart rates or low Apgar scores are present. High base deficit levels correlate with increased risk of complications like mortality, hypoxic-ischemic encephalopathy, or cerebral palsy. Whole body cooling is a neuroprotective therapy that can reduce risks of death or disability for newborns with hypoxic-ischemic encephalopathy.

Uploaded by

qisthiaufa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
318 views2 pages

Umbilical Cord Blood Gas Analysis Guide

This document discusses umbilical cord blood gas analysis, which provides an objective assessment of a newborn's metabolic condition at birth. Elevated base deficit levels in cord blood can indicate perinatal hypoxia or asphyxia, which are potential causes of conditions like cerebral palsy. Cord blood gases should be analyzed in high-risk pregnancies or when abnormal fetal heart rates or low Apgar scores are present. High base deficit levels correlate with increased risk of complications like mortality, hypoxic-ischemic encephalopathy, or cerebral palsy. Whole body cooling is a neuroprotective therapy that can reduce risks of death or disability for newborns with hypoxic-ischemic encephalopathy.

Uploaded by

qisthiaufa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Brian M.

Lappas
April 26, 2013

Umbilical Cord Blood Gas Analysis


Umbilical cord blood gas is the most objective way of assessing a newborns metabolic condition at birth.
Specifically, arterial cord pH and base deficit can determine perinatal hypoxia/asphyxia (potential causes
of hypoxic-ischemic encephalopathy or cerebral palsy) and give insight into causes of intrapartum fetal
distress.
When are cord blood gases indicated? including but not limited to:
High risk pregnancies
-C-section for fetal compromise
-Abnormal fetal heart rate patterns
-Low (3) Apgar score
-Intrapartum fever >100.4 C
-Multifetal gestation
Why do neonates get hypoxic/asphyxia?
3 main etiologies:
-Maternal oxygen compromised
-Maternal perfusion of placenta reduced
Preeclampsia, chronic hypertension, hypotension/hypovolemia, cyanotic heart disease
-Delivery of oxygenated blood from placenta to fetus is impaired
Placental abruption, cord prolapse, repetitive cord occlusion
How should it be collected and stored?
-10 to 20cm section of cord double clamped and put on ice
- Assessed accurately up to 60min, pH fall 0.05 at 30min, 0.087 at 60min, and 0.112 at 90min.
-Sample via cord artery, although paired venous sample recommended (artery < 0.09 venous)
What do the blood gases tell us?
Mean umbilical artery blood pH and gas in pre-term & term infants are similar
Pre-Term
Term
pH
7.21 -7.29
7.27 -7.28
pCO2 (mmHg)
49.2 -51.6
49.2 -50.3
HCO3 (mEq/L)
22.4-23.9
22.0-23.1
Base deficit (mEq/L)
2.5 - 3.3
2.7 - 3.6
Results of hypoxia/asphyxia on infants?
Pathological academia; increased association with 7.24 with mortality, hypoxic ischemic
encephalopathy, intraventricular hemorrhage, or cerebral palsy.
Severity of Deficit
Mild
Moderate
Severe

Amount of base deficit


Motor/Cognitive deficits 4-8 yo
4-8 mmol/L
None
8-12 mmol/L
12 mmol/L
10% had moderate/severe
16 mmol/L
40% had moderate/severe
-Only 4% of neonatal encephalopathic patients had hypoxia in absence of antepartum risk factors

Criteria to define aute intrapartum hypoxic event as sufficient to cause cerebral palsy:
- Evidence of metabolic acidosis (pH <7.0 and base deficit greater/equal 12 mmol/L)
- Early onset of moderate/severe neonatal encephalopathy in infants >34 week gestation
- Cerebral palsy of spastic quadriplegic or dyskinetic type
- Exclusion of other identifiable etiologies
Why does UNC do universal sampling?
Because there is a treatment to help reduce the risk of death or major disability in hypoxic-ischemic
encephalopathy by 20-30%.
-Hypothermia: whole body cooling or head selective cooling is the neuroprotective therapy for
neonatal encephalopathy.

Resources:
- ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid-base analysis. Obstet Gynecol. 2006 Nov;108(5):1319-22.
-Low JA, Lindsay BG, Derrick EJ. Threshold of metabolic acidosis associated with newborn complications. Am J Obstet Gynecol 1997; 177: 1391-4
-Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis.
BMJ. 2010 May 13;340:c1471
-UNC Umbilical Cord Blood Gases: Fetal acid base assessment at time of delivery. www.mombaby.org 2013
-Yeomans ER, Ramin SM. Umbilical cord blood acid-base analysis. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2013.

You might also like