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PERINATAL BRAIN DAMAGE: POOR PREDICTIVE VALUE OF METABOLIC ACIDOSIS AND APGAR SCORE

Asphyxia is usually defined by Apgar score, but brain damage is poorly predicted by even the 5 min score (A5). To assess the prognostic value of umbilical arterial pH, base excess, and lactate, we correlated them with A5 and adverse outcome (10 died, 60 had cerebral palsy or developmental delay at 1 yr) in 982 consecutive deliveries. Normal range (± 2SD) was derived from 106 cases with no maternal, pregnancy, delivery, neonatal, or developmental problems.Low pH (<7.16) was found in 95 cases (10%), 9 of them had adverse outcome. Low A5 (<8) was found In 29 cases (3%), 9 had adverse outcome. Combination of low pH with low A5 was seen in only 9 cases, 1 of them had adverse outcome. Of the 15 Infants with severe damage, 2 had low A5, 2 had low pH, and 1 had both. Base excess or lactate, singly or in combination, did not improve the predictive accuracy of A5 or pH.We conclude that although the specificity of A5 in relation to brain damage is high (98%), Its low sensitivity (13.4%) or predictive value (34.6%) is not improved by measurement of pH or related variables in umbilical arterial blood at birth.