Neonatal Clinical Outcomes: a Comparative Analysis

The most popular neonatal clinical outcomes, which are blood pH (PH), base excess (BE) and Apgar after 5 minutes from birth (AP5), may provide contrasting information. Thus, aim of the paper is to perform a critical evaluation and comparison of PH, BE and AP5. Reliability of neonatal clinical outcomes was evaluated in relation to perinatal features. Neonatal and fetal cardiotocographic data of 391 newborns (CTU-CHB Intrapartum Cardiotocography Database) were analyzed. Newborns were classified as positive (i.e., as showing critical conditions) if PH<7.10 or BE<-10mmol/l or AP5<7, as negative (i.e., as showing healthy conditions) otherwise. Agreement between pairs of neonatal clinical outcomes was evaluated by computing the correlation coefficient. Fetal decelerations were characterized in terms of rate of occurrence, depth, mean, duration, and area. Correlation between PH and BE, PH and AP5 and BE and AP5 was 0.83, 0.45 and 0.38 (P<0.01), respectively; 329 newborns (84%) were equally classified by all neonatal clinical outcomes, 5 as positive and 324 as negative. Deceleration depth and rate of occurrence were comparable among positive/negative classes, while deceleration mean, duration and area were systematically higher in the positive than in the negative classes, also statistically only for PH classification. Positive class by PH counted the highest number of small newborns; large newborns were similarly distributed over all positive classes. Objective neonatal clinical outcomes, and in particular PH, seems to be more reliable than subjective clinical outcomes, and thus should be preferable for describing neonatal health status.