DGRI NNU Guideline for Management of Cord Blood Gas Results
Samples should be taken from an umbilical artery and vein. If only one sample is available, arterial samples are preferable.
Cord blood gas should be assessed in the following circumstances:
- Emergency caesarean section
- Instrumental delivery
- If a fetal blood sample has been taken in labour
- If the baby’s condition at birth is poor
A member of the Paediatric Team should be alerted if the cord gas shows pH <7.2 or base deficit > -10.
The generally accepted cut-off value for pathological acidosis (risk of seizures, moderate to severe HIE and cerebral palsy) is an umbilical artery pH ≤7.0 (H+ ≥100). If the baby is well and cord gas results show pH >7.2 (H+ < 63) and BD < -10, then no further action is required. Consider repeating the gas after 60 minutes if pH 7.11 -7.2 (H+ 63 – 78) or BD > -10 on either sample – an assessment should be made and the decision based on clinical circumstances. For babies with cord blood gases indicating more severe acidosis, please follow the attached guideline.
Additional Notes:
- All babies with a cord pH ≤7.1 (H+≥79) should be commenced on the hypoglycaemia monitoring protocol (see WoS guideline)
- All infants with a cord pH ≤7.1 (H+ ≥79) should have a documented neurological examination
- The Consultant should be informed about all babies with cord pH ≤7.1 (H+ ≥79) who are clinically unwell, or where there is no improvement of acidosis on repeat blood gas sampling
- Ensure all cord gas results are documented on Badger
References:
- NHS D&G Neonatal Service/Cord Blood Gas Sampling/Update/Dec 2015
- Neuroprotection Care Pathway for the Management of Infants with Hypoxic Ischaemic Encephalopathy; The Scottish Cooling Group; September 2015
- Joint Trust Guideline for the Management of Babies with Severe Umbilical Artery Acidosis; Norfolk and Norwich University Hospitals NHS Foundation Trust; 20/02/2017
- Fetal and Cord Blood Sampling Guideline; North Devon Healthcare NHS Trust; August 2015
- Cord blood Collection/Analysis at Birth Clinical Practice Guideline; King Edward Memorial Hospital ; February 2018