In the different hospitals I have worked at over the years where the respiratory therapists either draw or run the umbilical cord gases I have often wondered about what the normal values of a cord gas was. Just from running a lot of cord gases I have came to my own conclusion of what a cord gas value should probably be but have never really looked into what the real normal values are and what a value out of the norm would mean.
I have done some research online to see what I could find out. Here are some fact about umbilical cord gases and the normal values:
- The umbilical cord blood is studied for the status of the fetal acid base. Cord gases are obtained to detect the presence or absence of acidosis and to decide whether the cause of the acidosis is respiratory or metabolic. Establishing the source and type of acidosis make it easier to a.) plan resuscitation b.) treat complications.
- Umbilical cord blood pH and acid-base balance is most useful in association with the delivery of an infant with a low APGAR score.
- Only newborns who have a persistent APGAR score of 0-3 for 5 minutes or longer and an umbilical artery blood pH of less than 7.00 are at risk of manifesting anoxic brain injuries.
- Premature infants are at higher risk for intracranial hemorrhage and subsequent neurological dysfunction, such as cerebral palsy. Without umbilical cord blood gas analysis, these neurological complications could be incorrectly attributed to intrapartum or birth asphyxia, especially if the latter is solely based on APGAR scores. Normal umbilical cord blood values in the premature infant virtually eliminate the diagnosis of significant intrapartum hypoxia or birth asphyxia.
The information I used above was found from different sources who are all basically saying the same thing. Now how about those normal values and the values the show a respiratory or metabolic acidosis.
As a reminder the umbilical cord is backwards as the Venous side carries the oxygenated blood and the Arterial side the unoxygenated blood. Doctors prefer to use the Venous cord blood but can assess PH with he arterial side also. Also these values are not set in stone, they are just a reference point, I have came across values the differ but very slightly.
| VEIN | ARTERY | |
| pH | 7.25 - 7.35 | 7.28 |
| p02 | 28 - 32 mmHg. | 16 - 20 mmHg. |
| pC02 | 40 - 50 mmHg. | 40 - 50 mmHg. |
| Base Excess | +/- 0 - 5 mEq/Liter | +/- 0 - 10 mEq/Liter |
| Respiratory Acidosis | Metabolic Acidosis | |
| pH | <> | < 7.25 |
| P02 | Variable | < 20 mmHg |
| pC02 | > 50 mmHg | 45 - 55 mmHg. |
| Base Deficit | < 10mEq/liter | > 10mEq/liter |
| Respiratory Acidosis | Metabolic Acidosis | |
| Low pH | Low pH | |
| High pC02 | Normal to high pC02 | |
| Normal Base Excess | High base excess |
As always I hope you have learned or been refreshed on this topic, I know just researching for this information I have learned a bit of information.
Thanks for reading.
Drive on RT's
11 comments:
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"Establishing the source and type of acidosis make it easier to a.) plan resuscitation b.) treat complications."
That's the stated reason. You see it written up in all the journals. The ugly truth is, when has any neo or ped made a treatment decision about a kid based on cord pH? In fact, in my 25 years experience, most of the cord gases are run anywhere from 15 to 45 minutes after the baby is born! You really want some doc waiting that long to treat your kid?
Cord gases are a CYA for the OB's. There's an 18 year statute of limitations on every delivery. If Johnny has a problem later on, and mom and dad decide to lawyer up, the OB can say "I didn't do it." Provided he has good cord pH's to back him/her up.
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Hi,
There is NO way you can treat a baby based on cord gases. After the PDA begins to close and the result of any venous or aterial drawn from the UAC is completely different than the cord gases.
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