Correlation Study Of Blood Gas Study Of Umbilical Artery And Apgar Scoring For Newborns With Asphyxia

Objective:To discuss about the correlation between indicators of umbilical artery blood gas and Apgar score of the newborn,its significance for evaluation of neonatal asphyxia and guidance value for clinical treatment.Methods:The prospective analysis was made in this study.160 newborns delivered in Women&Children’s Health Care Hospital of Linyi from June 2017 to December 2018 whose Apgar score was lower than 7 points were selected as the asphyxia group.Other 160newborns whose Apgar score was 8¹0 points were selected randomly as the non-asphyxia group for comparative analysis.The umbilical cords of all the newborns were cut within 5 minutes after the delivery.The umbilical cord was clipped 15cm away from the newborn,and 1ml umbilical arterial blood was drawn for blood gas analysis.At the same time,Apgar scores of the newborns were obtained 1min and 5min after they were born.If asphyxia recovery was required,Apgar scores were obtained 20min after they were born.The character of amniotic fluid,neonatal asphyxia and neonatal organ dysfunction were recorded.Results:1.Comparison of basic information of two groups of newborns.The asphyxia group of newborns included 94 baby boys and 66 baby girls,while the non-asphyxia group of newborns included 88 baby boys and 72 baby girls.There was no significant difference between the two groups（P﹥0.05）.In the asphyxia group the delivery method of 26 newborns was natural labor,that of 54 newborns was forceps delivery,and that of 80 newborns was cesarean delivery.In the non-asphyxia group the delivery method of 98 newborns was natural labor,that of 26 newborns was forceps delivery,and that of 36 newborns was cesarean delivery.There was significant difference between the two groups（P<0.05）.In the asphyxia group the birth weight of the newborns was（3.27±0.77）kg,while in the non-asphyxia group that was（3.43±1.16）kg.There was no significant difference between the two groups（P﹥0.05）.In the asphyxia group of newborns,there were 138 cases of single birth,and 22 cases of twins and above.In the non-asphyxia group of newborns,there were 146 cases of single birth,and 14 cases of twins and above.There was no significant difference between the two groups（P﹥0.05）.In the asphyxia group of newborns,there were 116 cases of firstborn,and 44 cases of the second child and above.In the non-asphyxia group of newborns,there were 102 cases of firstborn,and 58 cases of the second child and above.There was no significant difference between the two groups（P﹥0.05）.2.Value comparison of umbilical artery blood gas analysis and Apgar.The values of pH,PCO₂ and HCO₃ of the mild asphyxia group were higher than those of the severe asphyxia group.There was significant difference（P<0.05）.The values of BE and PO₂ of the mild asphyxia group were lower than those of the severe asphyxia group.There was significant difference（P<0.05）.The values of pH,PCO₂ and HCO₃ of the normal group were higher than those of the mild asphyxia group and the severe asphyxia group.There was significant difference（P<0.05）.The values of BE and PO₂ of the normal group were lower than those of the mild asphyxia group and the severe asphyxia group.There was significant difference（P<0.05）.3.Comparative analysis of pH value of umbilical artery blood and birth status of newborns.In 320 newborns,pH of 122 newborns was lower than 7.20,accounting for 38.13%.pH of 198 newborns was higher than 7.20,accounting for 61.87%.The incidence rate of amniotic fluid turbidity（96.72%）,organ dysfunction（91.80%）and asphyxia（86.89%）of the pH<7.20 group was significantly higher than that of the pH﹥7.20 group（9.09%,3.03%and 0%）.There was significant difference（P<0.05）.4.Comparative analysis of Apgar score and birth status of newbornsThe incidence rate of amniotic fluid turbidity（100%）,organ dysfunction（93.55%）and asphyxia（72.58%）of the group with Apgar of 0³ points was significantly higher than that of the group with Apgar of 4⁷ points（81.63%,53.06%and 51.02%）and Apgar>8points（20%,5.00%and 0%）,There was significant difference（P<0.05）.The incidence of turbidity,organ dysfunction and asphyxia in Apgar4-7 was higher than that in Apgar>8 group,the difference was statistically significant（P<0.05）.5.The evaluation of neonatal asphyxia with pH value of umbilical artery blood and Apgar scoreThe diagnostic consistency analysis was made on the diagnostic method in this study.The results showed that Kappa value of pH value was 0.56,Kappa value of Apgar score was 0.625 and Kappa value of Apgar+pH value was 1.Thus it can be seen that the accuracy of diagnosis of neonatal asphyxia with Apgar+pH value was higher.6.Evaluation of umbilical artery blood pH and Apgar score on neonatal organ function injuryThe sensitivity and specificity of pH value for neonatal organ dysfunction were94.92%and 95.05%,respectively.The sensitivity and specificity of Apgar score for neonatal organ dysfunction were 93.22%and 75.25%,respectively.The sensitivity and specificity of the combination of the two for the assessment of neonatal organ dysfunction were 98.39%and 99.24%,respectively.The sensitivity and specificity of the joint evaluation were significantly higher than the single evaluation,and the difference was statistically significant（P<0.05）.Conclusion:1.The blood gas analysis results of cord blood can reflect the severity of neonatal aspHyxia to a certain extent,and can be used as one of the objective indicators for clinically assisted neonatal aspHyxia and prognosis diagnosis.It has good accuracy and reliabilityfor evaluating neonatal aspHyxia and its prognosis.2.Umbilical artery blood pH and Apgar scores are of diagnostic value for neonatal aspHyxia and its adverse outcomes.The combined application of them can improve the accuracy of clinical diagnosis of neonatal aspHyxia.