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Gestational age-related reference values for Apgar score and umbilical cord arterial and venous pH in preterm and term newborns

Zaigham, Mehreen LU orcid ; Källén, Karin LU and Olofsson, Per LU (2019) In Acta Obstetricia et Gynecologica Scandinavica 98(12). p.1618-1623
Abstract

INTRODUCTION: Despite much literature on reference values of acid-base status in umbilical cord blood at birth, there are as yet no studies performed to determine gestational age-dependent references in cord venous blood and no studies on preterm acid-base standards. Similarly, the normal reference range of Apgar scores for term and preterm infants has not yet been determined.

MATERIAL AND METHODS: Data were obtained from the maternity units of Skåne University Hospital, Malmö and Lund, Sweden, from 2001 to 2010. Validated paired arterial and venous cord pH values were obtained from 27 175 newborns, of whom 18 584 had spontaneous, non-instrumental vaginal deliveries and a 5-minute Apgar score equal to or greater than the median... (More)

INTRODUCTION: Despite much literature on reference values of acid-base status in umbilical cord blood at birth, there are as yet no studies performed to determine gestational age-dependent references in cord venous blood and no studies on preterm acid-base standards. Similarly, the normal reference range of Apgar scores for term and preterm infants has not yet been determined.

MATERIAL AND METHODS: Data were obtained from the maternity units of Skåne University Hospital, Malmö and Lund, Sweden, from 2001 to 2010. Validated paired arterial and venous cord pH values were obtained from 27 175 newborns, of whom 18 584 had spontaneous, non-instrumental vaginal deliveries and a 5-minute Apgar score equal to or greater than the median value for the individual gestational week. Simple linear and polynomial regression analyses were performed. Values were reported as mean ± standard deviation and median with 2.5th and 97.5th percentiles.

RESULTS: Median 5-minute Apgar score was 7 for gestations shorter than 28 weeks, 8 for 28 weeks, 9 for 29-30 weeks, and 10 from 31 weeks onwards. A linear decline in pH for both cord arterial and venous blood was seen with advancing gestational age (P < 0.001).

CONCLUSIONS: Median 5-minute Apgar scores were <10 before 31 weeks of gestation. Both umbilical cord arterial and venous pH decreased linearly with increasing gestational age. Further studies are needed to show whether gestational age-related pH reference ranges might be preferred to fixed cut-offs in the estimation of umbilical cord acidemia at birth.

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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Apgar Score, Arteries, Fetal Blood/chemistry, Gestational Age, Humans, Hydrogen-Ion Concentration, Infant, Newborn, Premature Birth/physiopathology, Reference Values, Term Birth/physiology, Veins
in
Acta Obstetricia et Gynecologica Scandinavica
volume
98
issue
12
pages
1618 - 1623
publisher
Wiley-Blackwell
external identifiers
  • pmid:31318453
  • scopus:85070702256
ISSN
1600-0412
DOI
10.1111/aogs.13689
language
English
LU publication?
yes
additional info
© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.
id
7e4498e7-ee11-432a-9d4a-038b3083854e
date added to LUP
2020-06-11 21:18:29
date last changed
2024-10-03 03:27:51
@article{7e4498e7-ee11-432a-9d4a-038b3083854e,
  abstract     = {{<p>INTRODUCTION: Despite much literature on reference values of acid-base status in umbilical cord blood at birth, there are as yet no studies performed to determine gestational age-dependent references in cord venous blood and no studies on preterm acid-base standards. Similarly, the normal reference range of Apgar scores for term and preterm infants has not yet been determined.</p><p>MATERIAL AND METHODS: Data were obtained from the maternity units of Skåne University Hospital, Malmö and Lund, Sweden, from 2001 to 2010. Validated paired arterial and venous cord pH values were obtained from 27 175 newborns, of whom 18 584 had spontaneous, non-instrumental vaginal deliveries and a 5-minute Apgar score equal to or greater than the median value for the individual gestational week. Simple linear and polynomial regression analyses were performed. Values were reported as mean ± standard deviation and median with 2.5th and 97.5th percentiles.</p><p>RESULTS: Median 5-minute Apgar score was 7 for gestations shorter than 28 weeks, 8 for 28 weeks, 9 for 29-30 weeks, and 10 from 31 weeks onwards. A linear decline in pH for both cord arterial and venous blood was seen with advancing gestational age (P &lt; 0.001).</p><p>CONCLUSIONS: Median 5-minute Apgar scores were &lt;10 before 31 weeks of gestation. Both umbilical cord arterial and venous pH decreased linearly with increasing gestational age. Further studies are needed to show whether gestational age-related pH reference ranges might be preferred to fixed cut-offs in the estimation of umbilical cord acidemia at birth.</p>}},
  author       = {{Zaigham, Mehreen and Källén, Karin and Olofsson, Per}},
  issn         = {{1600-0412}},
  keywords     = {{Apgar Score; Arteries; Fetal Blood/chemistry; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Premature Birth/physiopathology; Reference Values; Term Birth/physiology; Veins}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{1618--1623}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Obstetricia et Gynecologica Scandinavica}},
  title        = {{Gestational age-related reference values for Apgar score and umbilical cord arterial and venous pH in preterm and term newborns}},
  url          = {{http://dx.doi.org/10.1111/aogs.13689}},
  doi          = {{10.1111/aogs.13689}},
  volume       = {{98}},
  year         = {{2019}},
}