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BMJ. 2010 May 13;340:c1471. doi: 10.1136/bmj.c1471.

Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis.

Author information

  • 1Department of Obstetrics, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham. g.l.malin@bham.ac.uk

Abstract

OBJECTIVE:

To evaluate the association between umbilical cord pH at birth and long term outcomes.

DESIGN:

Systematic review and meta-analysis.

DATA SOURCES:

Medline (1966-August 2008), Embase (1980-August 2008), the Cochrane Library (2008 issue 8), and Medion, without language restrictions; reference lists of selected articles; and contact with authors.

STUDY SELECTION:

Studies in which cord pH at birth was compared with any neonatal or long term outcome. Cohort and case-control designs were included.

RESULTS:

51 articles totalling 481 753 infants met the selection criteria. Studies varied in design, quality, outcome definition, and results. Meta-analysis carried out within predefined groups showed that low arterial cord pH was significantly associated with neonatal mortality (odds ratio 16.9, 95% confidence interval 9.7 to 29.5, I(2)=0%), hypoxic ischaemic encephalopathy (13.8, 6.6 to 28.9, I(2)=0%), intraventricular haemorrhage or periventricular leucomalacia (2.9, 2.1 to 4.1, I(2)=0%), and cerebral palsy (2.3, 1.3 to 4.2, I(2)=0%).

CONCLUSIONS:

Low arterial cord pH showed strong, consistent, and temporal associations with clinically important neonatal outcomes that are biologically plausible. These data can be used to inform clinical management and justify the use of arterial cord pH as an important outcome measure alongside neonatal morbidity and mortality in obstetric trials.

Comment in

PMID:
20466789
[PubMed - indexed for MEDLINE]
PMCID:
PMC2869402
Free PMC Article

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