Umbilical Cord Oxygen Content and Neonatal Morbidity at Term

The objective of this study was to investigate the relationship between umbilical cord partial pressure of oxygen (pO₂) at delivery and neonatal morbidity.

This is a secondary analysis of a prospective cohort study of term deliveries with universal cord gas collection between 2010 and 2014. The primary composite outcome of neonatal morbidity included neonatal death, meconium aspiration syndrome, intubation, mechanical ventilation, hypoxic-ischemic encephalopathy, and hypothermia treatment. Umbilical artery (UA), vein (UV), UV minus UA (Δ) pO₂, and hypoxemia (pO₂ ≤ fifth percentile) were compared between patients with and without neonatal morbidity. Areas under the receiver-operating characteristic curves were used to assess the predictive ability of pO₂.

Of 7,789 patients with paired umbilical cord pO₂, 106 (1.4%) had the composite neonatal morbidity. UA pO₂ was significantly lower in patients with neonatal morbidity compared with those without (median [interquartile range]: 16 (12, 21) vs. 19 (15, 24) mm Hg, p < 0.001). There was no difference in median UV pO₂ or ΔpO₂ between the groups. UA and UV hypoxemia were significantly more common in patients with neonatal morbidity. UA pO₂ had limited predictive ability for neonatal morbidity (area under the curve: 0.61, 95% confidence interval: 0.6-0.7).

Although UA pO₂ is significantly lower in patients with neonatal morbidity, it is a poor predictor of neonatal morbidity at term.