Umbilical cord arterial and venous gases, ionogram, and glucose level for predicting neonatal morbidity at term.

Objective: To determine which parameter of umbilical arterial cord gas analysis, pH, base deficit, lactate concentration, ionogram values, or glucose level index is the best predictor of neonatal morbidity at term.
Design: We conducted a 15-month retrospective cohort study that included all nonanomalous, singleton, term births at a single center. The predictive ability of lactate concentration, base deficit, pH, ionogram values, and glucose level were compared using receiver-operating characteristic curves for global and neurological composite morbidity. Optimal cutoff values for lactate concentration, base deficit, and pH were estimated based on their maximum area under the curve.
Results: We included 5161 newborns: 52 (1.01 %) had global composite morbidity, and 17 had (0.33 %) neurological composite morbidity. Blood levels of potassium, calcium, natremia, glucose level, and HCO ₃ ^- did not differ significantly between groups. pH, partial pressure of CO ₂ , partial pressure of O ₂ , base deficit, and lactate levels differed significantly between neonates in the groups with and without global composite morbidity. Nearly similar results were found for neurological composite morbidity. The predictive ability did not differ between arterial pH and arterial lactate concentration (P = .25) and base deficit (P = .79). Optimal cutoff values to predict global composite morbidity were arterial pH 7.144, venous pH 7.236, and arterial lactate concentration 6.5 mmol/L.
Conclusions: Acid-base status analysis remains the best objective indicator for predicting neonatal morbidity and can be estimated using pH, lactate, or base deficit. Ionogram cord blood composition and glucose level do not appear to be useful for this purpose.
Competing Interests: Declaration of Competing Interest None of the authors have any conflicts of interest or financial ties to disclose.
(Copyright © 2020 Elsevier B.V. All rights reserved.)