Clinical Study On The Diagnosis And Prognosis Of Umbilical Cord Blood Gas In Neonatal Asphyxia

Objectives:Study on the value of the diagnosis and prognosis of umbilical cord blood gas in neonatal asphyxia.Methods:FromJanuary 2012 through October 2014,302 singleton term appropriate for low Apgar score newborns in our hospital were consecutively enrolled in this prospective study. The following five items related to birth asphyxia, i.e.,1 min、5 min、10minApgar scores, umbilical artery blood pH, antepartum high-risk factors, organ injury, differential diagnosis on the causes of low Apgar score cases were examined and registered. The relationship among the first 4 items were analyzed. By differential diagnosis, the sensitivity and specificity of each index on diagnosing asphyxia and their complementary value on each other were investigated.The study focused on the distributive characteristics of umbilical artery blood pHand BE values of the asphyxiated and non-asphyxiated cases in low Apgar score group,as well as the sensitivity and specificity of different selected pH and BE threshold spots within their distributing ranges.SPSS19.0 statistical software for statistical analysis, P< 0.05, the difference was statistically significant.Results:The items (Apgar scores, umbilical artery blood pH, antepartum high-risk factors, organ injury) correlated well with each other (P< 0.05) but were not entirely parallel and consistent; they could complement but could not substitute for each other. The distributing ranges of the umbilical artery blood pH corrected values and BE values of the asphyxiated group were<7.00-<7.25 and<-10-<-20,respectively. Within the above ranges,none of selected spots with both high sensitivity and high specificity was found.The sensitivity of antepartum high-risk factors, low Apgar scores, umbilical artery blood pH< 7.00 and organ injury was 100%,100%,35.2%and 100%, while the specificity was 37.3%,9.3%,82.5% and 79.8%, respectively. Of the 302 low Apgar score cases in this series only 50.7% coincided with asphyxia. For the 302 cases, when low Apgar score was combined with umbilical artery blood pH< 7.15, the sensitivity and specificity were 52.3% and 96.7% and when low Apgar score was combined with umbilical artery blood pH< 7.25, the sensitivity and specificity were 69.3% and 62.4%, respectively. After organ injury was added, the specificity was increased to 94.0%. When differential diagnosis was further added to exclude the other causes of low Apgar score cases, the misdiagnosis rate was minimized.Conclusion:The umbilical cord blood analysis improve the diagnostic accuracy rate of neonatal asphyxia. In order.to increase diagnostic bases and reduce misdiagnosis, the criteria of sole Apgar score should be replaced by multi-index diagnostic criteria (Apgar scores, umbilical artery blood pH, antepartum high-risk factors, organ injury)...