title: High copeptin concentrations in umbilical cord blood after vaginal delivery and birth acidosis.
abstract: BACKGROUND
  The pituitary-secreted nonapeptide arginine-vasopressin (AVP) is unstable and therefore unsuited for diagnostic use, but its secretion can be estimated by measuring copeptin, the C-terminal portion of the AVP precursor (pro-AVP).
  
  
  OBJECTIVE
  Our objective was to investigate perinatal factors affecting copeptin concentrations in infants at birth and at 3 d of life.
  
  
  METHODS
  We conducted a prospective cross-sectional study at a tertiary university hospital.
  
  
  METHODS
  Copeptin plasma concentrations were evaluated in 177 infants at birth, including 117 paired arterial/venous umbilical cord and 102 venous blood samples obtained at 3 d of life.
  
  
  METHODS
  Copeptin concentrations were determined by a C-terminal pro-AVP luminescence immunoassay.
  
  
  RESULTS
  Arterial umbilical cord copeptin concentrations were consistently higher than matched venous ones (median 18 vs. 10 pmol/liter, P < 0.001), but both values were closely related (R(s) = 0.825; P < 0.001), and both were negatively related to arterial umbilical cord pH (R(s) arterial/venous = -0.578/-0.639; P < 0.001). Although exceedingly high copeptin concentrations were observed after vaginal birth in umbilical cord arterial [median (5-95% range) = 1610 (85-5000) pmol/liter] and venous [793 (6-4836) pmol/liter] plasma, copeptin concentrations were low after primary cesarean section [arterial/venous = 8 (3-907)/5 (5-504) pmol/liter]. Postnatal body weight loss was associated with increased copeptin concentrations at d 3 (R(s) = 0.438; P < 0.001) and was inversely related to copeptin concentrations at birth (R(s) = -0.289 and -0.309; both P = 0.001).
  
  
  CONCLUSIONS
  Vaginal birth is associated with a large release of copeptin that exceeds all values published so far, including those in critically ill adult patients with shock or brain injury. Thus, vaginal birth is arguably the most intense stressor in life.
authors: Department of Neonatology, University Hospital Zurich, Zurich, Switzerland. sven.wellmann@usz.ch
authors: Sven
authors: S
authors: Wellmann
authors: Jörg
authors: J
authors: Benzing
authors: Giuditta
authors: G
authors: Cippà
authors: Deborah
authors: D
authors: Admaty
authors: Ruth
authors: R
authors: Creutzfeldt
authors: Romaine Arlettaz
authors: RA
authors: Mieth
authors: Ernst
authors: E
authors: Beinder
authors: Olav
authors: O
authors: Lapaire
authors: Nils G
authors: NG
authors: Morgenthaler
authors: Ulrike
authors: U
authors: Haagen
authors: Gabor
authors: G
authors: Szinnai
authors: Christoph
authors: C
authors: Bührer
authors: Hans Ulrich
authors: HU
authors: Bucher
mesh_terms: D001127:Arginine Vasopressin / Q000097:blood*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D006020:Glycopeptides; C048197:copeptins; D001127:Arginine Vasopressin