title: Outcomes of extremely low birthweight infants with acidosis at birth.
abstract: OBJECTIVE
  To test the hypothesis that acidosis at birth is associated with the combined primary outcome of death or neurodevelopmental impairment (NDI) in extremely low birthweight (ELBW) infants, and to develop a predictive model of death/NDI exploring perinatal acidosis as a predictor variable.
  
  
  METHODS
  The study population consisted of ELBW infants born between 2002 and 2007 at National Institute of Child Health and Development (NICHD) Neonatal Research Network hospitals. Infants with cord blood gas data and documentation of either mortality prior to discharge or 18-22 month neurodevelopmental outcomes were included. Multiple logistic regression analysis was used to determine the contribution of perinatal acidosis, defined as a cord blood gas with a pH<7 or base excess (BE) <-12, to death/NDI in ELBW infants. In addition, a multivariable model predicting death/NDI was developed.
  
  
  RESULTS
  3979 patients were identified of whom 249 had a cord gas pH<7 or BE<-12 mEq/L. 2124 patients (53%) had the primary outcome of death/NDI. After adjustment for confounding variables, pH<7 and BE<-12 mEq/L were each significantly associated with death/NDI (OR=2.5 (1.6, 4.2) and OR=1.5 (1.1, 2.0), respectively). However, inclusion of pH or BE did not improve the ability of the multivariable model to predict death/NDI.
  
  
  CONCLUSIONS
  Perinatal acidosis is significantly associated with death/NDI in ELBW infants. Perinatal acidosis is infrequent in ELBW infants, however, and other factors are more important in predicting death/NDI.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Pediatrics, Rocky Mountain Hospital for Children, Denver, Colorado, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Randolph
authors.affiliation: Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina, USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Nolen
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Namasivayam
authors.initials: N
authors.lastname: Ambalavanan
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Myriam
authors.initials: M
authors.lastname: Peralta-Carcelen
authors.affiliation: Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina, USA.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.affiliation: Department of Pediatrics, Stanford University, Palo Alto, California, USA.
authors.forename: Alexis S
authors.initials: AS
authors.lastname: Davis
authors.affiliation: Department of Pediatrics, Brown University, Providence, Rhode Island, USA.
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan, USA.
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.affiliation: Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), Bethesda, Maryland, USA.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D000138:Acidosis / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Neonatology; Neurodevelopment