SYNOPSIS
RajivGandhiUniversity of Health Sciences, Karnataka, Bangalore
“STUDY OF CORRELATION BETWEEN umbilical artery
blood gas parameters and neonatal outcome.”
Name of the candidate:Dr. Merlin Reshma Pinto
Guide:Dr. K. Varadaraj Shenoy
Course and Subject :M.D (Paediatrics)
Department of Paediatrics,
FatherMullerMedicalCollege and Hospital
Kankanady, Mangalore – 575002.
August –2007
RajivGandhiUniversity of Health Sciences,
Karnataka, Bangalore.
Annexure – II
Proforma for registration of subject for dissertation
1 / Name of the Candidate and Address(in block Letters) / DR. Merlin reshma Pinto
Department of Paediatrics
FatherMullermedicalcollege, Kankanady, Mangalore – 575002.
2. / Name of the Institution / FatherMuller medicalcollege.
3. / Course of study and subject / m.d. – paediatrics
4. / Date of admission / 16.04.2007
5. / Title of the topic
STUDY OF CORRELATION BETWEEN umbilical artery blood gas parameters andneonatal outcome.
6.
7
8 / Brief Resume of the intended work
6.1 Need for the study
Considerable study has been expended to determine risk factors and the
role of intrapartum asphyxia causing adverse neonatal outcome in infants
delivered at term.
The most widely used methodology of assessment of neonatal outcome. APGAR scoring is semi objective1 and is not a reliable indicator of intrauterine asphyxia as well as immediate neonatal morbidity.
Umbilical artery / venous blood gas parameters have been used to assess foetal acidemia and neonatal outcome and is considered as gold standard objective tool for the assessment of intrauterine asphyxia2.
Umbilical blood gas values should always be obtained in high risk deliveries as it excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborn at term2.
There arecontroversies in interpretation of blood gas parameters because of lack of consistency with the definition of acidosis.
To date, studies have demonstrated increased risk for several adverse outcome events like seizures, hypoxic ischaemic encephalopathty, need for intubation with acidosis at birth1-10. Conversly, some authors have demonstrated little utility of umbilical blood gas parameters in determination of infants at risk for adverse outcome11-12.
Many studies which have been carried out are retrospective case control studies3,9,10,12 and some prospective studies have not used control group5,7.
Hence the present study is an attempt being done to correlate umbilical artery blood gas parameters with various measures of neonatal outcome.
6. 2 Review of Literature:
Umbilical arterial pH of less than 7.0 is associated with neonatal mortality in 5-9% cases3,4,5, other parameters were not significantly associated with neonatal mortality1-10it was also found to be associated withApgar score of less than 7 at 5 minutes in 31-64% of newborn.7,8,9,12.
Many studies have demonstrated that umbilicalarterial pH of less than 7.0 is associated with need for intubation in 26-50%4,7,8,12of newborns andBelai and co-workers10 found that umbilical arterial PaCO2 of more than 85mmHg is associated with need for intubation in 12% of term neonates.
Umbilical arterial acidemia is associated with seizures in 26-50% 3,5 and
hypoxic ischaemicencephalopathy in 23-60%of newborns5,7,12. Arterial
PaCO2 of more than 85mmHg is associated with seizures in 6% of term
neonates10 and base deficit of more than 15mmol/lhad no statistical
relationship with seizures5 .
Naegel and co-workers4 found weak correlation between umbilical arterial
pH and adverse neonatal outcome.
Socol and co-workers9 and Low and co-workers12 found that base deficit of
more than 15mmol/l is associated with adverse outcome in 25% of the term
neonates.
6.3 Aims and objectives
1)To determine the umbilical artery blood gas parameters in term normal neonates .
2)To determine the umbilical artery blood gas parameters in term neonates with evidence of foetal distress.
3)To correlate the umbilical artery blood gas parameters with the following measures of neonatal outcome viz.,
Neonatal mortality
Neonatal morbidity.
Material and Methods:
7.1Source of data:
Neonates born in Father Muller hospital from Aug 2007 to February 2009.
Study design:Prospective study.
60 cases and 30 controls.
7.2Sampling procedures: Purposive sampling technique.
Period of Study : one and half years.
Inclusion Criteria
Singleton, liveborn, neonates of gestational age >37 weeks with evidence of foetal distress -Foetal bradycardia/ tachycardia (heart rate >150bpm/
< 110 bpm respectively).
- Reduced base line variability.
- Decelerations and absence of accelerations on
cardiotocogram.
Exclusion Criteria:
Gestational age < 37 weeks.
Congenital anomalies.
Still births.
Neonatal morbidity includes:
Apgar scoring – < 4 at 1 minute and <7 at 5 minutes.
Need for intubation Minor – If requires continuous positive airway pressure or
transient ventilation ( < 24hrs ).
Severe -If requires mechanical ventilation >24 hours.
Seizures – Occuring within 48 hours of life.
Hypoxic ischaemic encephalopathy –
According to Sarnath and Sarnath Criteria11.
For the purpose of the study the umbilical arterial blood gas valueslaid down
by American college of Obstetrics and Gynaecology will be considered1
Statistical analysis: Data will be analysed by‘t’ test and logistic regression
analysis.
Procedure of Blood gas analysis:
Umbilical arterial blood sampling is done as it exactly represents
thefoetal acid base status than umbilical cord venous blood.
Umbilical artery is identified on the cut section of the cord which is doubly clamped, A syringe of 2 ml. flushed with 1/1000 of heparin solution is advanced into the artery and 1ml. of blood is collected, sample is kept air free and transported for analysis in ice packs within 30 minutes of collection . Analysis is done by AVL Compact 3 analyser.
7.3 Does the study require any investigation or interventions to be conducted
on patients or other humans or animals? If so, please describe briefly.
NO
7.4 Has ethical clearance been obtained from your institutions in case of 7.3
YES
References:
1) Bounstein L. N, “Cord gases to determine umbilical artery and
acid base analysis” ACOG bulletins, December 1996.
2)Thorp J.A, Rushing R.S, Umbilical cord blood gas analysis.
Obstetricsand Gynaecology Clinicsof North America.
December 1999,26(4), 695 – 709.
3) Saade A. R.L.,. Gilstrap .G, Wilkins L.C, .Zlatnik.I and Hankins.F. G.V.
Association between umbilical blood gas parameters and neonatal
morbidity and death in neonates with pathologic fetal academia.
Am J Obstet and Gynaecol: 1999, 181 (4), 867 – 871.
4) Nagel.H.T.C, Vandenbussche F. P, Oepkes, Dick H.A, Jennekens .S. A,
Laura A.E.M ,Bennebroek J.G.Follow – up of children born with an
umbilical arterial blood pH< 7” Am J Obstet and Gynaecol, 1995,
173 (6), 1758 – 1764.
5) Goodwin T. M, Belai I, Heranandez .P,Durnand .M. and Paul.R. H.
Asphyxial complications in the termnewborn with severe umbilical
acidemia. Am J Obstet and Gynaecol.1992, 167 (6), 1506 – 1512.
6)Winkler .C L.,.Hauth .J C, Tucker J.M, Owen J andBrumfield .C G..
Neonatal complications at term as related tothe degree of umbilical artery
academia. Am J Obstet and Gynaecol 1991, 164 (2), 637 – 641
7) Van den Berg.P P, Willianne .N.L.M., Jongsma.H.W, Nijland R ,Kolle
A.A, Nijhuis J et al,Neonatal complications in new borns with an
umbilical artery pH <7.00. Am J Obstet and Gynaecol: 1996, 175 (5),
1154 – 1157.
8)Victory .R, Deborah .P, Da Silva.O, Natale.R and Richardson .B.
Umbilical cord pH and base excess values in
relation to adverse outcome events for infants delivering at term
Am J Obstet and Gynaecol 2004, 191 (6), 2021 - 2028.
9) Socol.M.L, Garcia.P.M and Susan .R. “DepressedApgar Scores, acid base
status and neurologic outcome. Am J Obstet and Gynaecol, 1994,
170 (4), 991 – 998.
10) Belai .Y, Godwin .M T, Durand .M and Greenspoon .J.
Umbilical arteriovenous PO2 and PCO2 differences and neonatal
morbidity in term infants with severe acidosis. Am J Obstet and
Gynaecol 1998, 178(8), 13-19.
11) Goldaber.K. G, Gilstrap III .L. C, Leveno K.J., DaxJ S., Mcl Ntire .D.
Pathologic Fetal AcidemiaObstetrics and Gynaecology, 1991, 78 (6),
1103 – 1107.
1 12) Low J. A., Panagiotopoulos Cand E.June D,
“ Newborn complications after intrapartum asphyxia with metabolic acidosis in th the term foetus. Am J Obstet and Gynaecol, 1994, 170(4), 108 –1087.
9. / Signature of the candidate
10. / Remarks of the guide
11. / Name and designation of
( in block letters )
11.1 Guide
11.2 Signature
11.3 Head of the department / DR. K.VARADARAJ SHENOY, M.D, D.C.H.
PROFESSOR AND HEAD OF PAEDIATRICS
DEPARTMENT,
FATHERMULLERMEDICALCOLLEGE
MANGALORE.
DR. K.VARADARAJ SHENOY, M.D, D.C.H.
PROFESSOR AND HEAD OF PAEDIATRICS
DEPARTMENT,
FATHERMULLERMEDICALCOLLEGE
MANGALORE
12. / 12.1 Remarks of the chairman
and principal
12.2 Signature