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dc.contributor.authorAndersson, Charlotte Brix
dc.contributor.authorKlingenberg, Claus Andreas
dc.contributor.authorThellesen, Line
dc.contributor.authorJohnsen, Søren Paaske
dc.contributor.authorKesmodel, Ulrik Schiøler
dc.contributor.authorPetersen, Jesper Padkaer
dc.date.accessioned2024-10-09T11:27:15Z
dc.date.available2024-10-09T11:27:15Z
dc.date.issued2024-08-14
dc.description.abstractImportance Umbilical cord pH (UC-pH) level is an important objective indicator of intrapartum fetal hypoxia and is used to predict neonatal morbidity and mortality. A UC-pH value of less than 7.00 is often defined as a threshold for severe acidosis, but existing evidence is divergent and largely based on UC-pH measurements from selected populations; consequently, the results are challenging to interpret.<p> <p>Objective To investigate the association between UC-pH levels and the risk of adverse neonatal outcomes in a national setting with universal UC-pH measurement. <p>Design, Setting, and Participants This national, population-based cohort study included all liveborn, singleton, full-term infants without malformations born in Denmark from January 1, 2012, to December 31, 2018. Data were analyzed from January 1, 2023, to March 1, 2024. <p>Exposure Umbilical cord pH level categorized as less than 7.00, 7.00 to 7.09, 7.10 to 7.19 and 7.20 to 7.50 (reference group). <p>Main Outcomes and Measures The primary outcome was a composite of severe adverse neonatal outcomes: neonatal death, therapeutic hypothermia, mechanical ventilation, treatment with inhaled nitric oxide, or seizures. Secondary outcomes were individual components of the primary outcome, Apgar score, respiratory outcomes, and hypoglycemia. Data are presented as adjusted risk ratios (ARRs) with 95% CIs. <p>Results Among the 340 431 infants included, mean (SD) gestational age was 39.9 (1.6) weeks; mean (SD) birth weight was 3561 (480) g; and 51.3% were male. Umbilical cord pH of less than 7.20 was observed more often among infants with a gestational age of 40 or 41 weeks (31.6%-33.6% compared with 18.2%-20.2% at a gestational age of 39 weeks) and among male infants (53.9%-55.4% vs 44.6%-46.1% among female infants). Compared with the pH reference group (576 of 253 540 [0.2%]), the risk for the primary outcome was increased for the groups with UC-pH levels of less than 7.00 (171 of 1743 [9.8%]), 7.00 to 7.09 (101 of 11 904 [0.8%]), and 7.10 to 7.19 (259 of 73 244 [0.4%]). Comparable patterns were observed for the individual outcomes, except for neonatal death, which was only increased in the group with UC-pH levels of less than 7.10. The risk of treatment with continuous positive airway pressure was increased when UC-pH levels were less than 7.20, and the risk of hypoglycemia was 21.5% if UC-pH levels were less than 7.10. <p>Conclusions and Relevance In this cohort study of 340 431 newborn infants, results support and extend previous studies indicating a higher risk of adverse outcomes even at UC-pH levels above 7.00. The threshold for more intensive observation and treatment may be reconsidered.en_US
dc.identifier.citationAndersson, Klingenberg, Thellesen, Johnsen, Kesmodel, Petersen. Umbilical Cord pH Levels and Neonatal Morbidity and Mortality. JAMA Network Open. 2024;7(8):e2427604en_US
dc.identifier.cristinIDFRIDAID 2289535
dc.identifier.doi10.1001/jamanetworkopen.2024.27604
dc.identifier.issn2574-3805
dc.identifier.urihttps://hdl.handle.net/10037/35147
dc.language.isoengen_US
dc.publisherAmerican Medical Associationen_US
dc.relation.journalJAMA Network Open
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2024 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0en_US
dc.rightsAttribution 4.0 International (CC BY 4.0)en_US
dc.titleUmbilical Cord pH Levels and Neonatal Morbidity and Mortalityen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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Attribution 4.0 International (CC BY 4.0)
Med mindre det står noe annet, er denne innførselens lisens beskrevet som Attribution 4.0 International (CC BY 4.0)