Where's the Cord Gas? Variation in Umbilical Cord Blood Gas Sampling in High-Risk Deliveries

Umbilical cord blood gas (UCBG) sampling provides biochemical data to identify patients who may benefit from encephalopathy screening, but no standardized national guidelines are currently available. We aimed to determine the prevalence of UCBG sampling in high-risk deliveries at a level IV perinatal center in the absence of standardized collection guidelines and to describe subsequent hospital courses among deliveries without UCBG sampling.This was a single-center retrospective cohort study of high-risk deliveries at ≥36 weeks gestation from 2019 to 2021. High-risk deliveries were defined by acute obstetric events, operative delivery, or 5-minute Apgar ≤ 5. UCBG sampling was classified as attempted, obtained (arterial pH documented), or not attempted. Maternal, intrapartum, and neonatal characteristics were compared between attempted and not-attempted groups, and subgroup analyses evaluated infants without UCBG sampling to identify patients who qualified for encephalopathy screening.The study cohort was comprised of 1,144 (11%) high-risk deliveries, of which 1,034 remained after exclusions. UCBG sampling was attempted in 655 (63%) deliveries, and arterial results were obtained in 541 (52%). Among 131 neonatal intensive care unit (NICU) admissions, 105 (80%) had UCBG sampling attempted, and 83 (63%) had arterial results available. Among 41 NICU admissions with respiratory diagnoses and available admission blood gases, 5 met biochemical criteria for encephalopathy screening, and only 1 had a documented comprehensive neurological examination.The lack of standardized guidelines leads to inconsistent UCBG sampling in high-risk deliveries, highlighting the need for standardized UCBG screening criteria and coordinated obstetric-neonatal workflows. · UCBG sampling is the first red flag for hypoxic-ischemic encephalopathy detection.. · Lack of UCBG guidelines leads to inconsistent sampling.. · Establishment of UCBG sampling guidelines can limit practice variation..