They found that low cord pH did indicate a “strong, consistent, and temporal” association with outcomes that are “biologically plausible”. To that end, they did an extensive review of the literature to discern the relationship between acidosis at birth and neonatal morbidity and mortality. “It is therefore imperative that the validity of association is supported with high-quality evidence”, they say. With that said, Malin and colleagues acknowledge that cord pH is widely used to validate and defend clinical actions and to report research trial results. Therefore substantial uncertainty remains about the value clinicians may attach to acidosis in the clinical management of neonates and the long term implications of a low arterial cord pH”. They are instead derived through consensus, and “existing observational studies of the association between cord pH and outcomes have drawn inconsistent inferences. However, Malin et al say that while the criteria listed above are widely accepted, they are not evidence-based. Wong and MacLennan acknowledge that while some experts advise getting cord gases on all babies, they realize that this may not be practical. So it appears that getting ABG and acid-base data on high-risk babies is entirely appropriate. They also note that if their protocol were to be instituted, it would only represent approximately 2 % of all deliveries, and “should not be a drain on clinical resources”. They emphasize that a normal pH “excludes a causal relationship between an acute hypoxic intrapartum event and subsequent neurological disability”. These include the presence of severe metabolic acidosis (pH <7.0 and base deficit ≥12 mmol/L) in the arterial cord blood without evidence of chronic fetal pathology. In order for AIP to be a viable causative factor in CP, Wong and MacLennan say that several criteria must be met. Their retrospective study of 12,887 deliveries (babies who demonstrated an Apgar score of ≤6 at 5 minutes) in a hospital in Australia focused on the issues surrounding acute intrapartum hypoxia (AIP) and its relationship to cerebral palsy (CP). They explain that the information gained from a blood gas assessment of the umbilical cord (done in conjunction with other testing such as placental histology) will not only assist clinicians with diagnosis and counseling of the parents, it can also provide a defense in case of a lawsuit. Wong and MacLennan assert that cord gases should be utilized to help determine the cause of a baby’s low Apgar scores. One of those situations could be when a newborn displays a low Apgar score. Even with neonates who are in distress, there are some cautionary tales about where, when and how to draw ABGs.ĭiiulio explains that with regard to an ABG blood draw in a neonate, there are a number of considerations that don’t come into play when dealing with adults.įor example, these small patients don’t have the blood volume to tolerate multiple draws, so the justification for the testing needs to be very solid. What I found was a somewhat mixed bag, in terms of current opinions regarding whether routine ABGs are appropriate in healthy neonates. To get a handle on how neonates as patients, along with technique, results and treatment are currently intersecting with regard to ABG interpretation, I searched Medline, Ovid and CINAHL databases for the terms “neonates and blood gases”, “neonates and ABG interpretation” and “cord blood gas”. lab) while remaining sensitive to the special needs of neonates under their care. Therefore, those who draw ABGs must employ good technique and use the correct modality (point-of-care vs. Importantly, the ABG values may be a reflection of preanalytical issues if the results don’t make sense given the patient’s clinical presentation. Knowing how to interpret the ABG results allows RTs, nurses and other clinicians who draw ABGs to anticipate and prepare for treatment courses and clinical outcomes. analysis of the acid-base status of the patient. There is little question that when any patient, including a neonate, is critically ill, the ABG results give clinicians essential information, i.e. And while the results are important drivers of clinical care, there are questions about whether arterial blood gas (ABG) testing is always necessary or desirable in this patient population.Īs well, if you are a nurse or respiratory therapist (RT) drawing the ABG, how can you know if the results are worth the effort and pain to the patient? A review of the literature yields mixed answers. Blood gases are the most common tests done on neonates.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |