Metabolic Acidemia in Live Births at 35 Weeks of Gestation or Greater

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Abstract

OBJECTIVE: To estimate the incidence of metabolic acidemia and assess its association with a variety of obstetric complications in a large cohort of singleton live births at 35 weeks of gestation or greater. METHODS: We analyzed obstetric complications and neonatal outcomes associated with metabolic acidemia in singleton newborns delivered at 35 weeks of gestation or greater. Metabolic acidemia was identified as an umbilical artery pH of less than 7.0 and a base deficit of 12 mmol/L or greater from umbilical cord blood gas analyses performed immediately after delivery. The primary outcome of interest was seizures in the immediate newborn period. RESULTS: Between January 1, 1988, and December 31, 2013, a total of 1,265 (3.9/1,000, 95% confidence interval [CI] 3.7-4.1) neonates were identified with metabolic acidemia among 323,027 live births with cord gas analysis. Virtually every recorded obstetric complication was significantly associated with metabolic acidemia. All measures of neonatal morbidity except necrotizing enterocolitis were also significantly increased in the presence of metabolic acidemia. Seizures occurred in 367 of 323,027 (1.1/1,000, 95% CI 1.0-1.3) neonates. Only 19.1% (95% CI 15.2-23.5%) occurred in those with metabolic acidemia. Among the 1,265 with metabolic acidemia, 70 were diagnosed with neonatal seizures, for a prevalence of 5.5% (95% CI 4.3-6.9) in the acidotic group. CONCLUSION: Neonatal acidemia at birth is rare in deliveries occurring at or after 35 weeks of gestation. Seizures occur in less than one in 10 newborns with metabolic acidemia. Approximately 80% of seizures in neonates at this gestational age occur in nonacidemic neonates. LEVEL OF EVIDENCE: III

Original languageEnglish (US)
Pages (from-to)279-283
Number of pages5
JournalObstetrics and Gynecology
Volume126
Issue number2
DOIs
StatePublished - Aug 23 2015

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Live Birth
Seizures
Pregnancy
Confidence Intervals
Obstetrics
Necrotizing Enterocolitis
Blood Gas Analysis
Umbilical Arteries
Fetal Blood
Gestational Age
Gases
Parturition
Morbidity
Incidence

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{13eefd456bbd496e8b9a41228b4f1ff3,
title = "Metabolic Acidemia in Live Births at 35 Weeks of Gestation or Greater",
abstract = "OBJECTIVE: To estimate the incidence of metabolic acidemia and assess its association with a variety of obstetric complications in a large cohort of singleton live births at 35 weeks of gestation or greater. METHODS: We analyzed obstetric complications and neonatal outcomes associated with metabolic acidemia in singleton newborns delivered at 35 weeks of gestation or greater. Metabolic acidemia was identified as an umbilical artery pH of less than 7.0 and a base deficit of 12 mmol/L or greater from umbilical cord blood gas analyses performed immediately after delivery. The primary outcome of interest was seizures in the immediate newborn period. RESULTS: Between January 1, 1988, and December 31, 2013, a total of 1,265 (3.9/1,000, 95{\%} confidence interval [CI] 3.7-4.1) neonates were identified with metabolic acidemia among 323,027 live births with cord gas analysis. Virtually every recorded obstetric complication was significantly associated with metabolic acidemia. All measures of neonatal morbidity except necrotizing enterocolitis were also significantly increased in the presence of metabolic acidemia. Seizures occurred in 367 of 323,027 (1.1/1,000, 95{\%} CI 1.0-1.3) neonates. Only 19.1{\%} (95{\%} CI 15.2-23.5{\%}) occurred in those with metabolic acidemia. Among the 1,265 with metabolic acidemia, 70 were diagnosed with neonatal seizures, for a prevalence of 5.5{\%} (95{\%} CI 4.3-6.9) in the acidotic group. CONCLUSION: Neonatal acidemia at birth is rare in deliveries occurring at or after 35 weeks of gestation. Seizures occur in less than one in 10 newborns with metabolic acidemia. Approximately 80{\%} of seizures in neonates at this gestational age occur in nonacidemic neonates. LEVEL OF EVIDENCE: III",
author = "Morgan, {Jamie L.} and Casey, {Brian M.} and Bloom, {Steven L.} and McIntire, {Donald D.} and Leveno, {Kenneth J.}",
year = "2015",
month = "8",
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doi = "10.1097/AOG.0000000000000923",
language = "English (US)",
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pages = "279--283",
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TY - JOUR

T1 - Metabolic Acidemia in Live Births at 35 Weeks of Gestation or Greater

AU - Morgan, Jamie L.

AU - Casey, Brian M.

AU - Bloom, Steven L.

AU - McIntire, Donald D.

AU - Leveno, Kenneth J.

PY - 2015/8/23

Y1 - 2015/8/23

N2 - OBJECTIVE: To estimate the incidence of metabolic acidemia and assess its association with a variety of obstetric complications in a large cohort of singleton live births at 35 weeks of gestation or greater. METHODS: We analyzed obstetric complications and neonatal outcomes associated with metabolic acidemia in singleton newborns delivered at 35 weeks of gestation or greater. Metabolic acidemia was identified as an umbilical artery pH of less than 7.0 and a base deficit of 12 mmol/L or greater from umbilical cord blood gas analyses performed immediately after delivery. The primary outcome of interest was seizures in the immediate newborn period. RESULTS: Between January 1, 1988, and December 31, 2013, a total of 1,265 (3.9/1,000, 95% confidence interval [CI] 3.7-4.1) neonates were identified with metabolic acidemia among 323,027 live births with cord gas analysis. Virtually every recorded obstetric complication was significantly associated with metabolic acidemia. All measures of neonatal morbidity except necrotizing enterocolitis were also significantly increased in the presence of metabolic acidemia. Seizures occurred in 367 of 323,027 (1.1/1,000, 95% CI 1.0-1.3) neonates. Only 19.1% (95% CI 15.2-23.5%) occurred in those with metabolic acidemia. Among the 1,265 with metabolic acidemia, 70 were diagnosed with neonatal seizures, for a prevalence of 5.5% (95% CI 4.3-6.9) in the acidotic group. CONCLUSION: Neonatal acidemia at birth is rare in deliveries occurring at or after 35 weeks of gestation. Seizures occur in less than one in 10 newborns with metabolic acidemia. Approximately 80% of seizures in neonates at this gestational age occur in nonacidemic neonates. LEVEL OF EVIDENCE: III

AB - OBJECTIVE: To estimate the incidence of metabolic acidemia and assess its association with a variety of obstetric complications in a large cohort of singleton live births at 35 weeks of gestation or greater. METHODS: We analyzed obstetric complications and neonatal outcomes associated with metabolic acidemia in singleton newborns delivered at 35 weeks of gestation or greater. Metabolic acidemia was identified as an umbilical artery pH of less than 7.0 and a base deficit of 12 mmol/L or greater from umbilical cord blood gas analyses performed immediately after delivery. The primary outcome of interest was seizures in the immediate newborn period. RESULTS: Between January 1, 1988, and December 31, 2013, a total of 1,265 (3.9/1,000, 95% confidence interval [CI] 3.7-4.1) neonates were identified with metabolic acidemia among 323,027 live births with cord gas analysis. Virtually every recorded obstetric complication was significantly associated with metabolic acidemia. All measures of neonatal morbidity except necrotizing enterocolitis were also significantly increased in the presence of metabolic acidemia. Seizures occurred in 367 of 323,027 (1.1/1,000, 95% CI 1.0-1.3) neonates. Only 19.1% (95% CI 15.2-23.5%) occurred in those with metabolic acidemia. Among the 1,265 with metabolic acidemia, 70 were diagnosed with neonatal seizures, for a prevalence of 5.5% (95% CI 4.3-6.9) in the acidotic group. CONCLUSION: Neonatal acidemia at birth is rare in deliveries occurring at or after 35 weeks of gestation. Seizures occur in less than one in 10 newborns with metabolic acidemia. Approximately 80% of seizures in neonates at this gestational age occur in nonacidemic neonates. LEVEL OF EVIDENCE: III

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U2 - 10.1097/AOG.0000000000000923

DO - 10.1097/AOG.0000000000000923

M3 - Article

VL - 126

SP - 279

EP - 283

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 2

ER -