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Am J Perinatol 2017; 34(07): 668-675
DOI: 10.1055/s-0036-1597135
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neurologic Injury in Acidemic Term Infants

Alison G. Cahill
1   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Amit M. Mathur
2   Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
,
Christopher D. Smyser
3   Division of Neurology, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
,
Robert C. Mckinstry
4   Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
,
Kimberly A. Roehl
1   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Julia D. López
1   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
,
Terrie E. Inder
5   Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
,
George A. Macones
1   Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

23 September 2016

28 October 2016

Publication Date:
07 December 2016 (online)

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Abstract

Objective To determine whether arterial umbilical cord gas (aUCG) pH, in anatomically normal-term infants, could select infants at risk for brain injury identified on magnetic resonance imaging (MRI).

Study Design We performed a nested case-control within a prospective cohort of 8,580 women. Cases, with an aUCG pH < 7.10, were temporally, age, and sex matched to controls with an aUCG pH ≥ 7.20. Bi- and multivariable analyses compared the presence and severity of brain injury. Secondary analyses estimated whether elevated arterial base excess or lactate were associated with brain injury.

Results Fifty-five cases were matched to 165 controls. There was no statistical difference in brain injury between the groups (adjusted odds ratio [aOR]: 1.8, 95% confidence interval [CI]: 0.7–4.4]). Base excess ≥ −8 mEq/L was not significantly associated with brain injury (p = 0.12). There was no increase in risk of injury based on elevation of arterial lactate ≥ 4 mmol ⁄L (p = 1.00). Cases were significantly more likely to have an abnormal score in several domains of the Dubowitz neurologic examination.

Conclusion The aUCG acid-base parameters alone are not sufficient clinical markers to identify term infants that might benefit from MRI of the brain to identify injury.

Keywords

brain injury - academia - arterial umbilical cord gas pH - magnetic resonance imaging

Note

This study was presented orally as an abstract at the 35th annual meeting of the Society of Maternal and Fetal Medicine, San Diego, CA, February 2–7, 2015.


 

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