Background Umbilical cord lactate is one approach to measuring acidosis and intrapartum hypoxia, knowledge of which may be helpful for clinicians involved in the care of women and newborns.Objective To synthesise the evidence on accuracy of umbilical cord lactate in measuring acidosis and predicting poor neonatal outcome.Search strategy Studies published and unpublished between 1990 and 2014 from PubMed/Medline, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were assessed.Selection criteria Cross-sectional and randomised studies that assessed fetal acidosis (using lactate as the index test) with or without an assessment of neonatal outcome.Data collection and analysis Correlations between index and reference test(s) were recorded, as were the raw data to classify the predictive ability of umbilical lactate for neonatal outcomes. Metaanalysis of correlation was performed. We plotted estimates of the studies' observed sensitivities and specificities on Forest plots with 95% confidence intervals (CI). Where possible, we combined data using meta-analysis, applying the hierarchical summary receiver operating characteristics model and a bivariate model.Main results Twelve studies were included. Umbilical lactate correlated with pH [pooled effect size (ES) À0.650; 95% CI À0.663 to À0.637, P < 0.001], base excess (ES À0.710; 95% CI À0.721 to À0.699, P < 0.001), and Apgar scores at 5 minutes (ES 0.300; 95% 0.193-0.407, P < 0.001). Umbilical lactate had pooled sensitivity and specificity for predicting neonatal neurological outcome including hypoxic ischaemic encephalopathy of 69.7% (95% CI 23.8-94.4%) and 93% (95% CI 86.8-96.3%).Authors' conclusion Umbilical cord lactate is a clinically applicable, inexpensive and effective way to measure acidosis and is a tool that may be used in the assessment of neonatal outcome.
(BJOG 2017;124:584–594) Testing for acidosis at all deliveries is advocated by some as an early and effective way to identify infants at risk for a range of adverse neonatal outcomes. A low umbilical artery potential of hydrogen (pH) has been associated with poor outcomes such as cerebral palsy, encephalopathy, and death. While acidosis is not the direct cause of these negative outcomes and most acidotic newborns suffer no adverse effects, knowledge of the presence of the acidosis may allow clinicians to alter their treatment in an attempt to improve outcomes.
A study was carried out on 391 cases of bronchiolitis and pneumonia from different paediatric units in Rawalpindi/Islamabad, Pakistan. A clear winter spike of respiratory syncytial virus (RSV) was noted. It was found that there was a substantial increase of 30-50% in the positivity of RSV from December to February.
Subacute sclerosing panencephalitis (SSPE) remains a problem in areas of the world where measles virus is prevalent because of a lack of commitment to universal vaccination. We recently studied 89 cases compatible with a clinical diagnosis of SSPE and tested for antibody in serum or cerebrospinal fluid for measles virus. Eleven cases were confirmed to be SSPE on the basis of strongly supportive laboratory data.
Objective: To assess outcomes of neonates born to mothers who were COVID-19 positive. Study Design: Prospective observational study. Place and Duration of Study: Secondary and Tertiary Care Hospitals of the Armed Forces, Pakistan, from Apr to Aug 2020. Methodology: We studied 106 pregnant women who tested positive for SARS-CoV-2. Stable asymptomatic newborn babies were kept in SARS-CoV-2 specified incubators, at specially designated areas for observation. Nasopharyngeal swabs were taken at first 24 hours and if negative, babies were handed over to clinically stable mothers who were educated regarding use of facemasks and proper hand washing. Neonates who tested positive for SARS-CoV-2 were evaluated for SARS-CoV-2 again at 48 hours and then every 48-72 hours, until found to be negative. Results: Total 106 women were found to be SARS-CoV-2 positive during the study period. All the women delivered singleton babies. Of the 106 babies, 5 (4.71%) were found to be positive for SARS-CoV-2 at 24 hours and only 1 (0.94%) baby was found to be positive at 48 hours and then tested negative at 7th day. Conclusion: Babies born to SARS-CoV-2 mothers were mostly asymptomatic and there was no increased risk of morbidity or mortality to the neonates suffering from the infection.
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