Severe umbilical cord acidemia and neurological outcome in preterm and full-term neonates.
BACKGROUND
Severe intrauterine hypoxia-ischemia and acidemia may lead to a disturbed neurodevelopment.


OBJECTIVE
To study the effects of acidemia at birth on neurodevelopment in preterm and full-term neonates.


METHODS
Short- and long-term outcome were studied retrospectively in 44 inborn preterms and 95 full-terms with severe acidemia at birth defined as a pH of the umbilical artery <7.00. Outcome was compared with 67 preterm and 90 full-term non-acidemic neonates (pH>7.15). Intraventricular hemorrhage (preterms) or seizures (both preterms and full-terms) were considered an adverse short-term outcome. Neonatal death, cerebral palsy or neurodevelopmental delay were considered an adverse long-term outcome.


RESULTS
Severe intraventricular hemorrhage (IVH) occurred in 5 of the 44 (11%) acidemic preterms and in none of the 67 (0%) non-acidemic preterms (p<0.01). Seizures were observed in 9 of the 44 (20%) and 11 of the 95 (12%) acidemic preterms and full-terms, respectively, and in none of the 67 (0%) and 1 of the 90 (1%) non-acidemic preterms and full-terms, respectively (p<0.001 for preterms, p<0.01 for full-terms). Nine preterms (6 acidemic, 3 non-acidemic) and 2 full-terms (both acidemic) died in the neonatal period. Adverse long-term outcome occurred in 32% of the acidemic preterms, in 21% of the non-acidemic preterms, in 7% of the acidemic full-terms and in 7% of the non-acidemic full-terms.


CONCLUSIONS
Acidemia at birth increased the occurrence of severe IVH in preterm neonates and seizures in both preterm and full-term neonates. However, no significant effect of acidemia on long-term outcome could be demonstrated.
Lavrijsen
Selma W
SW
Division of Perinatology and Gynecology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Uiterwaal
Cuno S P M
CS
Stigter
Robert H
RH
de Vries
Linda S
LS
Visser
Gerard H A
GH
Groenendaal
Floris
F
D000138:Acidosis / Q000097:blood*; D002543:Cerebral Hemorrhage / Q000097:blood; D002657:Child Development; D005260:Female; D005312:Fetal Blood / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D020925:Hypoxia-Ischemia, Brain / Q000097:blood*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood*; D011247:Pregnancy; D012189:Retrospective Studies; D012640:Seizures / Q000097:blood; D011795:Surveys and Questionnaires