Abstract
Introduction
Umbilical cord blood gas and lactate levels reflect the fetus’s well-being in utero and at the time of delivery. Various cutoff levels have been reported for umbilical cord blood lactate to determine the severity of perinatal asphyxia, but their association with early neonatal outcomes has not been understood.
Methodology
This prospective observational study was carried out in the delivery room of a tertiary care hospital in North Karnataka. Umbilical cord arterial blood was collected from double-clamped cord segments after neonatal delivery by trained nursing staff. Cord lactate levels were measured using an automated analyzer (Xpress2 Lactate Analyzer R) located in the delivery ward.
Results
The median cord blood lactate was significantly higher among neonates who were admitted to the neonatal intensive care unit (NICU) with the diagnosis of birth asphyxia (52; Q1, Q3: 41.3, 91) when compared to those without birth asphyxia (29; Q1, Q3: 18, 44). Also, cord blood lactate was significantly higher for those who had a low appearance, pulse, grimace, activity, and respiration (APGAR) score at 5 min, those who required bag and mask ventilation (BMV) and ventilatory support [including continuous positive airway pressure (CPAP) for transient tachypnea of the newborn].
Conclusion
An optimal cutoff of 41.5 mg/dL (4.6 mmol/L), with sensitivity of 78.6% and specificity of 71.5%, area under the curve (AUC) 0.77 [95% confidence interval (CI): 0.64, 0.91], was predictive of significant birth asphyxia at birth. This study provides the data to determine the cutoff for cord lactate to be used in busy delivery rooms and peripheral health setups for early recognition of significant perinatal asphyxia for prompt referral of the newborn to avail adequate post-asphyxia care.
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