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Different types of acid-base changes at birth, fetal heart rate patterns, and infant outcome at 4 years of age
A Herbst1, K Thorngren-Jerneck, L Wu
1Department of Obstetrics and Gynecology, University Hospital, University of Lund, Sweden.
Insights
Neonatal acidemia, identified by fetal heart rate patterns, did not show long-term developmental differences in infants. However, mixed acidemia correlated with increased NICU admissions and potential speech deficits.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Developmental Pediatrics
Background:
- Investigating the link between umbilical cord blood acidemia types at birth and fetal heart rate (FHR) patterns during labor.
- Assessing the impact of these conditions on infant long-term developmental outcomes.
Purpose of the Study:
- To determine the relationship between pure high base deficit and mixed acidemia in newborns.
- To correlate specific FHR patterns with these acidemia types.
- To evaluate long-term neurodevelopmental outcomes at age 4 years.
Main Methods:
- A case-control study comparing infants with pure high base deficit (BD > or = 12 mmol/L, pCO2 < 8.0 kPa) and mixed acidemia (BD > or = 12 mmol/L, pCO2 > or = 8.0 kPa) with matched controls.
- Analysis included FHR patterns during labor and developmental screening at age 4.
Main Results:
- Late decelerations were linked to pure high base deficit; complicated variable decelerations to mixed acidemia.
- Both acidemia types correlated with low Apgar scores (<7 at 1 min).
- Mixed acidemia led to more neonatal intensive care unit (NICU) admissions; no significant developmental differences were found at age 4, though some speech/language deficits were noted in mixed acidemia cases.
Conclusions:
- FHR patterns like late decelerations may indicate metabolic acidemia, while complicated variable decelerations suggest mixed acidemia.
- Concomitant hypercapnia in mixed acidemia might impact neonatal outcomes, evidenced by higher NICU admission rates.
- Further research is needed to explore the association between birth acidemia and speech/language development deficits.
Background:
To study the relationship between different types of acidemia in umbilical artery blood at birth, fetal heart rate (FHR) patterns during labor, and infant long-term outcome.
Methods:
Case-control study of 48 infants with pure high base deficit (base deficit (BD) > or = 12 mmol/L and pCO2 < 8.0 kPa), 51 with mixed acidemia (BD > or = 12 mmol/L and pCO2 > or = 8.0 kPa), born at or after term, and controls matched for maternal age, parity, and gestational age at birth. FHR patterns during labor and the results of developmental screening at age 4 were compared between the groups.
Results:
Late decelerations were associated with pure high base deficit and complicated variable decelerations with mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute, and mixed acidemia with more admissions to the neonatal intensive care unit. Developmental screening at age 4 years showed no significant differences between infants with mixed acidemia or pure high base deficit and controls. Twelve infants with mixed acidemia and six controls had deficits in language/speech development.
Conclusions:
Late decelerations may be an indicator of a metabolic component of acidemia and complicated variable decelerations an indicator of mixed acidemia. The higher rate of admissions to the neonatal intensive care unit in cases with mixed acidemia may suggest that a concomitant hypercapnia (resulting in lower pH) in metabolic acidemia at birth may be of importance for the outcome. A possible relation between acidemia at birth and deficits in speech/language development should be further evaluated.