Changes in Umbilical Artery Blood Gas Values with the Onset of Respiration

Ullrich, J.R.; Ackerman, Bruce D.

doi:10.1159/000240488

Cited by 18 publications

(33 citation statements)

References 7 publications

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“…The picture is more variable than that seen in the first 20 sec [8]. Whereas no increases in pH were observed in group 1 of the prior study [8], in the present study several infants showed a distinct increase in pH.…”

Section: Methodscontrasting

confidence: 74%

“…For 13 of the 17 infants, Cl was at 20 sec or later. Comparison with the previous study [8] indicates that the present study dealt mainly with a later sequence of events, both in terms of elapsed time and number of breaths.…”

Section: Methodsmentioning

confidence: 63%

“…The methods used for blood gas analysis and interpretation were indentical with those used in the previous study [8], Figure 1 shows the changes in pH, from Cl to C2, for these 17 infants. The picture is more variable than that seen in the first 20 sec [8].…”

Section: Methodsmentioning

confidence: 99%

“…A technique for serial sampling of umbilical artery blood at birth was described in a prior report [1], A second study utilizing this technique showed that the first 4-5 breaths appear not to be effective ventilations, and that blood gas values consistently become more asphyxial over the first 20 sec after birth [8], In the present study, serial samples were obtained at a later point in time, such that, for some infants, improvement occurred in the arterial blood gas values from the first to the second sampling. The data reported in the present study suggest that the fifth breath is the approximate point at which there is reversal of the trend toward increasing asphyxia following birth and the beginning of a trend toward improvement in the infant's blood gas values.…”

Section: Introductionmentioning

confidence: 99%

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Time of Onset of Effective Ventilation at Birth

Chou

Ullrich

Ackerman³

1974

Neonatology

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A method for serial sampling of umbilical artery blood was described in a previous report. Another study using this method demonstrated that the umbilical artery blood becomes more asphyxial over the first 20 sec after birth, even though up to 5 breaths occurred over this time. In the present study, serial samples of umbilical artery blood were function obtained at slightly later intervals; the first samplings occurred at 11–41 sec and the second samplings at 22–59 sec. From 3 to 11 breaths occurred between birth and the second sampling. Unlike the results in the prior study, many infants showed a rising pH, a falling PCO₂, and a rising oxygen saturation from the first to the second sampling. When the results of one of the prior studies are combined with the present study, it appears that the fifth breath represents the approximate point of reversal of the trend from one of increasing asphyxia to one of improvement in blood gas values. The fifth breath usually occurred at 20–30 sec. It may be advantageous to allow the placental respiration to continue until the pulmonary respiration becomes effective by delaying cord clamping until 5 breaths have occurred or until 30 sec have elapsed.

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Section: Methodscontrasting

confidence: 74%

Section: Methodsmentioning

confidence: 63%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Time of Onset of Effective Ventilation at Birth

Chou

Ullrich

Ackerman³

1974

Neonatology

Self Cite

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“…[1][2][3] These changes towards acidaemia and lactaemia can be explained by the 'hidden acidosis' phenomenon. During uterine contractions, the fetal circulation is centralised at the expense of perfusion of low-priority organs and peripheral tissues, 4 with a build-up of acid metabolites peripherally.…”

Section: Introductionmentioning

confidence: 99%

Hidden acidosis: an explanation of acid–base and lactate changes occurring in umbilical cord blood after delayed sampling

Mokarami

Wiberg

Olofsson

2013

BJOG

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Objective To explore the 'hidden acidosis' phenomenon, in which there is a washout of acid metabolites from peripheral tissues in both vaginal and abdominal deliveries, by investigating temporal umbilical cord blood acid-base and lactate changes after delayed blood sampling.Design Prospective comparative study.Setting University hospital.Sample Umbilical cord blood from 124 newborns.Methods Arterial and venous cord blood was sampled immediately after birth (T 0 ), and at 45 seconds (T 45 ), from unclamped cords with intact pulsations taken from 66 neonates born vaginally and 58 neonates born via planned caesarean section at 36-42 weeks of gestation. Non-parametric tests were used for statistical comparisons, with P < 0.05 considered significant.Main outcome measures Temporal changes (T 0 -T 45 ) in umbilical cord blood pH, the partial pressure of CO 2 (P CO 2 ) and O 2 (P O 2 ), and in the concentrations of lactate, haematocrit (Hct), and haemoglobin (Hb).Results In both groups all arterial parameters, except for P CO 2 in the group delivered by caesarean section, changed significantly (pH decreased and the other variables increased). There were corresponding changes in venous acid-base parameters. When temporal arterial changes were compared between the two groups, the decrease in pH and increase in P CO 2 were more pronounced in the group delivered vaginally. Neonates born vaginally had significantly lower pH and higher lactate, Hct, and Hb concentrations at T 0 and T 45 in both the artery and the vein. At T 45 , arterial P CO 2 and P O 2 levels in the group delivered vaginally were also significantly higher.Conclusions Delayed umbilical cord sampling affected the acidbase balance and haematological parameters after both vaginal and caesarean deliveries, although the effect was more marked in the group delivered vaginally. The hidden acidosis phenomenon explains this change towards acidaemia and lactaemia. Arterial haemoconcentration was not the explanation of the acid-base drift.

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Respiration and the Respiratory System

Harned

1978

Perinatal Physiology

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Changes in Umbilical Artery Blood Gas Values with the Onset of Respiration

Cited by 18 publications

References 7 publications

Time of Onset of Effective Ventilation at Birth

Time of Onset of Effective Ventilation at Birth

Hidden acidosis: an explanation of acid–base and lactate changes occurring in umbilical cord blood after delayed sampling

Respiration and the Respiratory System

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