title: Neurologic Injury in Acidemic Term Infants.
abstract: ObjectiveTo 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 DesignWe 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.ResultsFifty-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.ConclusionThe 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.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Mathur
authors.affiliation: Division of Neurology, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Smyser
authors.affiliation: Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Mckinstry
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Julia D
authors.initials: JD
authors.lastname: López
authors.affiliation: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Inder
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000138:Acidosis / Q000175:diagnosis*; D001784:Blood Gas Analysis / Q000379:methods; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008923:Missouri; D015999:Multivariate Analysis; D011446:Prospective Studies; D012720:Severity of Illness Index; D047929:Term Birth