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Bösing, M.
Short and Long Term Outcome of Children with Fetal Acidosis - A retrospective explorative study.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2016. pp. 80
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- Authors Med Uni Graz:
- Advisor:
- Lang Uwe
- Reif Philipp
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- Abstract:
- Introduction. Fetal acidosis, defined as umbilical artery pH smaller than 7.20, is an established indicator for hypoxic distress of the neonate during delivery. Nowadays, the umbilical artery pH is routinely measured in almost all obstetric centers. There is consensus in literature that severe fetal acidosis with an umbilical artery pH lower than 7.0 is associated with neonatal morbidity and mortality. Long term outcome, on the other hand, is not sufficiently studied yet. This study is an attempt to analyze and comprehensively present the short and long term outcome of children with fetal acidosis, depending on its severity. Material and methods. The population of this retrospective study included 14,924 neonates with umbilical artery pH (UA pH) = 7.20, who were born in one of the public hospitals in Styria between 2004 and 2012. On the one hand, possible influence factors on the severity of acidosis were analyzed. On the other hand, short term outcome was investigated in terms of neonatal mortality, reanimation rate, intubation and ventilation rate, rate of transfer to a neonatal intensive care unit (NICU), as well as Apgar scores. For long term outcome findings of the developmental diagnostics program at the Department of Pediatrics, Medical university of Graz, were evaluated for a sub-group of maturely born children with UA pH < 7.10. Results. Up to 17.8 % of premature neonates with = 32+0 weeks’ gestation suffered from severe acidosis with UA pH < 7.0. This was significantly more than in those born = 32+0 weeks’ gestation (up to 8.9%, p = 0.015). The highest average UA pHs (7.15) were found in neontaes delivered spontaneously or by primary c-section. Average UA pH values were significantly lower in neonates after emergency c-section (7.09, p < 0.001), vaginal-operative delivery (7.14, p < 0.001), or vaginal delivery from breech presentation (7.11, p < 0.001). Neonates with UA pH < 7.0 showed significantly poorer outcome than those with less severe forms of acidosis for all analyzed short term outcome parameters (p < 0.001). Rates of reanimation and transfer to NICU were significantly higher for newborns with UA pH < 7.10 (p < 0.001), while rates of intubation and O2-application were already significantly higher for newborns with UA pH < 7.15 (p < 0.001). In maturely born neonates (GA = 37+0 wks) the reanimation rate was at 3.3% even significantly higher for neonates with UA pH between 7.15 and 7.19 than for non- or pre-acidotic infants (2.3% and 2.4% respectively, p < 0.001). In neonates with low 5’-Apgar scores (< 4) moderately acidotic infants (UA pH < 7.15) showed a clinically highly relevant mortality of 66.7%, which was significantly higher than in pre- and slightly acidotic newborns (p = 0.003). For the long term outcome analysis no statistically significant results were obtained because of the small sample size (n = 48). Most children of this collective either presented development appropriate for age (10/48), or were not even invited for an appointment at the developmental diagnostics program (28/48). Only two children showed major deficits in verbal and/or motor development, both had suffered from severe acidosis at birth. Three children showed minor developmental deficits. Conclusion. The results of this study are consistent with findings of previous studies. Severe acidosis with UA pH < 7.0 proofed to be a good predictor for neonatal morbidity and mortality. For neonates with 5-mintue Apgar scores lower than 4 an UA pH of 7.14 and lower is already associated with high neonatal mortality. The analysis of long term outcome showed that the majority of even advanced to severely acidotic newborns develops appropriately for age, long term developmental deficits are rather an exception.