Differences between umbilical blood gas in term and preterm newborns

Electronic Physician Pub Date : 2019-02-25 DOI:10.19082/7529
M. Tataranno, De Bernardo De Bernardo, D. Trevisanuto, D. Sordino, M. Riccitelli, G. Buonocore, S. Perrone
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引用次数: 6

Abstract

Introduction: Cord blood gas analysis reflects placental respiratory and metabolic function and is commonly used to assess fetal status at birth. Our aim was to identify the differences in blood gas parameters between the umbilical artery (UA) and umbilical vein (UV) in term and preterm infants. Methods: This was a prospective pilot study. Umbilical cord artery and UV samples were consecutively collected from 225 term and 57 preterm infants at the University Hospital of Padua and at the neonatal unit of Ruesch Hospital in Naples, Italy. Blood gas-analysis and glucose measurement were performed in all samples. Term infants were divided into adequate for gestational age (AGA) and small for gestational age (SGA) according to birth weight percentile. Data were analyzed using Pearson Product-Moment Correlation, independent-samples t-test, and paired-samples t-test. A p-value <0.05 was considered statistically significant. Results: The median gestational age of preterm and term newborns were 34 weeks (±2) and 39 weeks (±1) respectively. The pH, pO2, were lower and pCO2, HCO3 and base excess (BE) were higher in the UA compared with the UV, in both AGA and SGA term infants. In preterm infants, no statistically significant differences were found between the UA and UV regarding pH, while the pO2 was lower and pCO2 was higher in the UA than UV (respectively: 22.5 vs. 32.4 and 53.1 vs. 42.8; p<0.0001). In the UA, pO2, BE and potassium (K+) were lower (respectively: 22.5 vs. 25.1; -2.5 vs. -3.7; 4.8 vs. 5.8; p<0.001) while sodium (Na+) and calcium (Ca++) were higher in preterm than term newborns (respectively: 135.7 vs. 133.6; p<0.001; 1.4 vs. 1.3; p<0.001). Glycaemia was lower in the UA than in the UV in all newborns (respectively: 66 vs. 77 in AGA term newborns; 63 vs. 71 in SGA term newborns; 68 vs. 76 in preterm newborns; p<0.0001) and was related to venous glycaemia measured in the first hour of life (n= 282, r =0.60; p<0.001). Conclusions: Significant differences in blood gas parameters between the UA and UV in term and preterm newborns suggest the importance of the placental barrier and the need for accurate cord blood gas analysis interpretation at birth. UA and UV samples at birth are required to assess with higher accuracy the metabolic status of the newborn in utero. Further studies are needed to evaluate if cord glycemic values could be a noninvasive tool for prediction of glycaemia during the first hour of life.
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足月新生儿和早产儿脐血血气的差异
脐带血气分析反映胎盘的呼吸和代谢功能,通常用于评估胎儿出生时的状态。我们的目的是确定在足月和早产儿脐带动脉(UA)和脐带静脉(UV)之间的血气参数的差异。方法:前瞻性先导研究。从意大利帕多瓦大学医院和那不勒斯Ruesch医院新生儿病房的225名足月婴儿和57名早产儿中连续采集脐带动脉和紫外线样本。所有样品均进行血气分析和血糖测定。按出生体重百分位数将足月婴儿分为足胎龄儿(AGA)和小胎龄儿(SGA)。数据分析采用Pearson积差相关、独立样本t检验和配对样本t检验。p值<0.05认为有统计学意义。结果:早产儿和足月新生儿中位胎龄分别为34周(±2)和39周(±1)。与UV相比,AGA和SGA足月婴儿UA的pH、pO2较低,pCO2、HCO3和碱过量(BE)较高。在早产儿中,UA和UV在pH方面无统计学差异,而UA的pO2低于UV, pCO2高于UV(分别为22.5 vs. 32.4和53.1 vs. 42.8;p < 0.0001)。在UA中,pO2、BE和钾(K+)较低(分别为22.5 vs. 25.1;-2.5 vs. -3.7;4.8 vs. 5.8;p<0.001),而钠(Na+)和钙(Ca++)在早产儿中高于足月新生儿(分别为135.7比133.6;p < 0.001;1.4 vs. 1.3;p < 0.001)。在所有新生儿中,UA组的血糖均低于UV组(分别为66比77;SGA足月新生儿63 vs 71;早产儿68比76;P <0.0001),且与出生后1小时静脉血糖相关(n= 282, r =0.60;p < 0.001)。结论:足月新生儿和早产儿UA和UV血气参数差异显著,提示胎盘屏障的重要性和出生时准确的脐带血气分析解释的必要性。出生时的UA和UV样本需要更准确地评估新生儿在子宫内的代谢状态。需要进一步的研究来评估脐带血糖值是否可以作为预测生命最初一小时血糖的无创工具。
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