Benirschke K, Kaufman P. Architecture of normal villous trees, In: Pathology of the Human Placenta, 2nd edition. Correpondence of this manuscript should be addressed to: Case 10: Umbilical Cord Occlusion with Terminal Fetal Bradycardia, Mild. The change is a progressive decrease in pH and base excess, and an increase in pCO2 and lactate. This makes good sense if there is a period of time preceding total venous occlusion when the blood in the umbilical vein is slowed rather than halted. This acid base calculator estimates both the anion gap and provides you with an arterial blood gas interpretation. Which interpretation of these umbilical cord and initial neonatal blood results is correct? The most important measurements used in arterial cord blood gases examination are the baby's pH levels and their base deficit. New York, Academic Press, 1967, p279. This reflects the fact that it is the umbilical vein that carries oxygenated blood rather than the umbilical artery. Fetal and maternal circulation is proximate at the placenta where gas/nutrient exchange between maternal and fetal circulation occurs. Unlike other blood samples obtained through a vein, a blood sample from an . Sodium and chloride are required for anion gap calculation. Analyzing cord blood gases (oxygen O2 and carbon dioxide CO2) from the umbilical artery is believed to be a good representation of the fetal acid-base status immediately before birth. Base buffers have been used to maintain oxygenation B. Obstet Gynecol 2006; 108: 1319-22, Andersson O, Hellstrom-Westas L, Andersson D, Di Tommasso M, Seravalli V, Martini I. Deorari , AIIMS 2008 2 Contents 1. It is these values that describe the baby's metabolic state. ARC Blood Gas Analysis 6 125 (H+).The hydrogen ions are buffered by desaturated hemoglobin, and HCO3 - is transported out of the eryth- rocytes into the plasma (Figure 6-3).1 As oxygen is unloaded from hemoglobin along the tissue capillaries, increased base deficit) thus implies that sometime during labor, oxygenation of fetal tissues was severely compromised. SID means Strong Ion Difference (SIDa and SIDe for SID apparent or effective). The assessment should take place within 60 minutes. 60 minutes. a negative base excess) is defined by the amount of strong base that must be added. Arterial Blood Gas (ABG) Interpretation: Practice Problems, Answers, & Cheatsheet. If a baby suffered from hypoxia that resulted in a birth injury, the blood cord gases can prove the legitimacy of the plaintiff's claim. The case settled and I got a lot more money than I expected. Westgate JA, Bennett L, Gunn AJ. The close juxtaposition of arteries and vein in the umbilical cord makes it quite possible to sample venous blood in the mistaken belief that it is arterial blood [20]. Yeomans ER, Hauth JC, Gilstrap LC III, Strickland DM. Arterial blood gases (ABGs) are commonly used for estimating the acid-base status, oxygenation and carbon dioxide concentration of unwell patients. Delay in clamping may result in significant change in acid-base parameters; the longer the delay, the greater is the change. At time of cord clamp: Double clamp and divide a ~10-15 cm segment of cord and place on delivery table* * time for blood gas assessment: 60 minutes from clamped cord segment, 60 minutes in heparin flushed syringe at room temp. Blood cord gases results can be used as an important piece of evidence in birth injury litigation. This so-called hidden acidosis phenomenon is thought to be a transient physiological effect of initiation of neonatal breathing [13] and can give a false impression of significant acidosis at birth. Arch Dis Child 1988;63:570-1. The standard technique of sampling cord blood for gas and acid-base analysis comprises three steps: clamping a segment of the cord removing the clamped cord segment needle aspiration of two blood samples (one venous, one arterial) from the excised clamped cord segment into preheparinized syringes 1. . Umbilical cord pH, PCO2, and bicarbonate following uncomplicated term vaginal deliveries. CRRT Clearance. Indeed, most (around 75 %) babies with significant metabolic acidosis (pH <7.0, base excess. Equivalent Oxygen Weight Calculator. 08 Sep 2021. Advantages of routine (non-selective) cord blood gas testing: Disadvantages of routine (non-selective) cord blood gas testing: Proponents of routine cord blood gas analysis also argue that it can be used as an audit of the effectiveness of the fetal monitoring and intervention strategies used in the unit to prevent significant metabolic acidosis and associated neonatal morbidity and mortality. After separation from maternal circulation, and throughout life, oxygenated blood is carried in arteries from lungs to the tissues and deoxygenated blood is carried from tissues back to the lungs in veins). Curr Opin Obstet Gynecol 2001; 13: 141-45, Gjerris A, Staer-Jensen J, Jorgenson J. Umbilical cord blood lactate: a valuable tool in the assessment of fetal metabolic acidosis. What's the diffe. (18,19) This is difficult to study because of the rarity of delivery room resuscitation that includes volume expansion. How long can umbilical cord blood gases remain stable in a heparinized syringe at room temperature? A needle withdraws blood that is in the cord. Basal Energy Exp. - carboxy- hemoglobinemia, Decreased fetal oxygen-carrying capability, Chronic maternal conditions: Johnson JWC, Richards DS. An ABG calculator is a tool that provides an easy way to determine the acid-base status by inputting the pH, PaCO2, and HCO3- values. When blood flow ceases in the umbilical arteries, the umbilical arterial blood gas will only reflect the fetal blood gas status at the time blood stopped flowing (see Table above). Base excess is defined as the amount of strong acid that must be added to each liter of fully oxygenated blood to return the pH to 7.40 at a temperature of 37C and a pCO2 of 40 mmHg (5.3 kPa), while a base deficit (ie. Paediatric Child Health 2012; 17: 41-43, Mokorami P, Wiberg N, Olofsson P. Hidden acidosis: an explanation of acid-base and lactate changes occurring in umbilical cord blood after delayed sampling. Interpreting Arterial Cord Blood Gas Values. 26 Oct 2021. However, doctors can also use blood cord gases to defend birth injury lawsuits as well. The infant was then delivered by outlet forceps. All human beings including the fetus inside the uterus before birth depend on two gases, oxygen, and carbon dioxide are being exchanged, oxygen enters the body and carbon dioxide exits the body. Given these difficulties, it is widely recommended [2, 20-22] that blood from both artery and vein are sampled and analyzed, so that arterial blood results can be validated as truly arterial. Umbilical venous pressure and Doppler flow pattern of inferior vena cava in the fetus. Because pH is the most reproducible of the three measured blood gas parameters, looking at the difference between pHs to alert to an abnormally large difference is most helpful. Our specific aim was to develop a standardized clinical care pathway, ensuring timely identification and evaluation of neonates with umbilical-cord acidemia at risk for HIE.METHODS. Adult arterial (non-cord) blood values (for comparison only). Asphyxia is reduced tissue oxygen (hypoxia) of sufficient severity and duration to cause metabolic acidosis [5]. CrCl Measured. Am J Obstet Gynecol 2010; 202: 546 e1-7, Nordstom L. Lactate measurement in scalp and cord arterial blood. - chronic hypertension This calculator only differentiates between acute (pH abnormal) and compensated (pH normal). The results from cord blood gases are frequently used as evidence in medical malpractice lawsuits by both attorneys and doctors as a marker for the harm done to the child and to prove whether negligence was involved in a child's injury. Blood gas interpretation for neonates Blood gas interpretation for neonates Key messages Blood gases are helpful to assess the effectiveness of ventilation, circulation and perfusion. Then label each "column" as "acid", "pH", and "base". The lack of consensus on this issue among national expert bodies is reflected in obstetric practice around the world; some obstetric units having a selective policy, whilst others are routinely performing cord blood gas analysis at all births. BACKGROUND. Review ABG Interpretation with Cathy! APGAR Scores; Braden Scale . Altogether, they help to determine the status of the patient - their acid-base balance. The mother was a 26-year-old, gravida 4, para 3, aborta 0, with an intrauterine pregnancy at 40 0/7 weeks' gestation by good dates. As previously discussed, it is vital that arterial blood is sampled for analysis. However, when umbilical cord occlusion associated with terminal bradycardia is the underlying pathology, the umbilical artery sample typically has a worse base deficit than in the umbilical vein sample. However, the associated hypoxemia is of insufficient severity or duration to cause hypoxia and consequent metabolic acidosis. In summary, these studies have confirmed that cord-blood lactate concentration is a good predictor of cord-blood pH and base excess, and that it is at least as good as pH and base excess in predicting outcome. Value: Normal Range: Abnormal Values: pH. The umbilical-cord blood data contained in the table is derived from a study [1] of all 19,600 live births (>20 weeks gestation) at a tertiary care obstetrics unit during a 3-year period; results are consistent with smaller, earlier studies [2, 3]. Blood gases can be performed from cord, arterial, venous or capillary specimens. Can occur after delayed cord clamp. When she inhales, she picks up oxygen into her blood that is carried to the placenta and fetus. accurately in order to calculate exact base excess. Intrapartum, by fetal scalp blood sampling. The baby might have had poor circulation and perfusion shortly before being born or they could have experienced a physical head injury during delivery. What is the pH (and what do we accept in newborns)? The pH, base excess and pCO2 (acid-base status) of arterial blood flowing through the umbilical cord provides valuable objective evidence of the metabolic condition of neonates at the moment of birth; a notion that has assured a role for the blood gas analyzer in hospital delivery suites in cases of suspected fetal distress/asphyxia. The clinical value of cord blood gas analysis lies in its ability to provide objective evidence of asphyxia at the moment of birth. Br J Obstet Gynaecol 1999;106:664-71. It follows, theoretically at least, that arterial cord-blood lactate concentration should be as reliable an indicator of birth asphyxia and risk of HIE as the more established tests, arterial cord-blood pH and base excess. Intrapartum care: Care of healthy women and their babies during childbirth. 2008; 139: 16-20, Koshnow Q, Mongelli M. Cord blood lactate and pH values at term and perinatal outcome: a retrospective cohort study. The wider the differences between umbilical venous and arterial samples, likely the longer the interval of umbilical vein obstruction with the restored umbilical arterial flow. Some experts define fetal acidemia as a pH of less than 7.1. pH difference <0.02 and/or pCO2 difference <0.5 kPa), then the two samples almost certainly came from the same vessel, either a vein or an artery. However, it seems safe to assume that a difference of 4 mmol/L or more is significant. Randomized trial of volume infusion during resuscitation of asphyxiated neonatal piglets. Arterial Blood Gas (ABG) Calculator pH : PaCO2 : mm Hg HCO3 : mEq/L Result : Please fill out required field. This potential safety audit function of universal cord blood gas testing is addressed by a recent study [1] that suggests adoption of a universal testing policy resulted in improved perinatal outcomes. Obstet Gynecol 1992; 79: 959-62. When the baby is born, the umbilical artery briefly retains information about the baby's current condition, referred to as blood cord gases. Immediately after birth, ideally before the babys first breath, an approximate 20-cm segment of the cord must be isolated between two sets of two clamps. What must you do with the air in the heparinized syringe? Interpreting umbilical cord blood gases and detecting birth asphyxia The most important measurements in a blood gas test for evaluating a baby's current condition and prognosis are the pH and the base deficit. Significant metabolic acidosis (i.e. For many years it has been standard obstetric practice to clamp the umbilical cord within seconds of birth, a policy that is, as discussed above, coincidentally fortuitous for the most accurate assessment of neonatal acid-base status. Remove ALL air and gently rotate for 30 seconds . Once the fetus uses this blood, it is carried away from the heart and back to the placenta by both umbilical arteries into the placenta and then to the mother. Cap both ends and mix 20 times by gentle inversion. Anion Gap = Na - (HCO + Cl) Gap-Gap Ratio =. Delay in clamping by as little as 45 seconds after birth results in significant change in acid-base parameters [13-15]; the longer the delay, the greater is the change [16, 17]. Observations on fetal heart rate and fetal biochemistry III: Base deficit of umbilical cord blood. You are asked to review a 63-year-old female who was admitted with shortness of breath. The prevalence of metabolic acidosis can be used as an outcome measure for testing the efficacy of novel fetal monitoring strategies. In the intervillous space of the placenta, carbon dioxide diffuses from the fetus into the mothers blood and the mother can eliminate it by exhalation through her lung. Causticizing Efficiency Calculator. If cord blood banking planned, attempt to set aside only 10 cm Normal Arterial Blood Gas Values pH : 7.36-7.44 PaCO2 : 36-44 mm Hg HCO3 : 22-26 mEq/L Legal Notices and Disclaimer All Information contained in and produced by the Pediatric Oncall system is provided for educational purposes only. Vanhaesebrouck P, Vanneste K, de Praeter C, van Trappen Y. White C, Doherty D, Henderson J et al. We calculated Spearman correlation coefficients and receiver operating characteristic curves for various levels of umbilical artery pH, base excess, and Apgar scores. 1.37 = Milliliters of oxygen bound to 1 g of hemoglobin at 100 percent saturation Hb = Hemoglobin concentration (g/dl) SaO 2 = Percent of hemoglobin bound to oxygen (%) 0.03 = Solubility factor of oxygen in plasma (ml/mm Hg) PaO 2 = Oxygen partial pressure in arterial blood (mm Hg) Edwards AL. The readout from the machine quotes normal values based on the assumption that the sample analysed is arterial (an ABG). Normal values of umbilical arterial samples in a preterm newborn: *The P in PCO2 and PO2 stands for partial pressure, which is how these umbilical cord blood gases are measured. FO . The levels determine if the baby has acidosis, a condition caused by the overproduction of acid in the blood. A fetus relies on the mother for oxygen and carbon dioxide exchange. (3,4) Finding a pH difference greater than 0.10 suggests either cord occlusion with terminal bradycardia or chronic fetal heart failure with terminal bradycardia. Program: Blood Gas Interpretation Chart, 3rd Ed (5-Pack) $ 30.00 Based on the Siggaard-Andersen Acid-Base Alignment Nomogram, this tool allows you to accurately interpret a neonatal blood gas result in seconds. It was a good review of ABG analysis. Info. There are wide ranges of umbilical cord gas values which can be considered normal. 7.35-7.45. pH < 7.35 indicates ACIDOSIS (ACID) Molar Heat Vaporization Calculator. Immediately after birth, ideally before the babys first breath, an approximate 20-cm segment of cord must be isolated between two sets of two clamps. The pH, PCO2, and base deficit change quite slowly in a completely occluded umbilical vessel, likely because much of the surrounding tissue (Wharton's jelly) has very little metabolic activity and accordingly utilizes very little oxygen and produces very little carbon dioxide. During labor, the FHR monitor revealed recurrent variable decelerations that were deeper and longer-lasting, and then a deceleration to 60 bpm for three minutes. Abnormal cord blood gas results are a marker for a birth injury. There may have been an error in the process of storing and analyzing the blood. However, arterial blood can be difficult to obtain due to weak pulses or patient movement. - SLE So, the umbilical cord contains three blood vessels: one large vein carrying oxygenated blood to the fetus and two much smaller arteries carrying deoxygenated blood that is relatively rich in carbon dioxide and other metabolic waste products from the fetus. The test also checks the balance of acids and bases, known as the pH balance, in your blood. - antiphospholipid syndrome, TABLE II: Factors that may affect fetal oxygenation in labor [7]. Early Human Development 2010; 86: 329-38, Perlman J. Intrapartum hypoxic-ischemic cerebral injury and subsequent cerebral palsy. It does not determine if a baby should be cooled. Arch Dis Child 1987;62:1276-7. The design of this study depended on the policy of universal cord blood gas testing that had been adopted in the obstetric unit where the study was conducted. Presented by Ellis Jacobs, PhD, Assoc. Median (5th-95th percentile):PH:7.27 (7.12 7.35); pO2: 16.3 mmHg (6.2-27.6); PCO2:55.1 mmHg (41.9-73.5);Bicarbonate:24.3 mmol/L (18.8-28.2);Base excess:-3.00 mmol/L (-9.3 to +1.5);Lactate:3.7 mmol/L (2.0-6.7). The calculator also determines whether the state is compensated or uncompensated. So when HCO 3 - is raised the pH is increased as there are less free H+ ions (alkalosis). ANZJOG 2011; 51:17-21. I understand that submitting this form does not create an attorney-client relationship. Cord blood P o2 and P co2 The blood gas analyser measures pH, P co2 and P o2 and then calculates base excess after normalising P co2. The other values impact pH and BE, but pH and BE are the main numbers examined to determine if the baby suffered from a lack of oxygen to the brain either shortly before . In one study [27], for example, the introduction of ST waveform analysis as an adjunct to fetal ECG monitoring resulted in a remarkable reduction in the prevalence of significant metabolic acidosis (0.72 % of all live births to 0.06 %). Calcium Equivalents. Among the most important information we can gain from blood gas values is the pH of the blood. Johnson and Richards (7) have reported that in cases of umbilical cord prolapse, umbilical venous PO2, oxygen saturation, and oxygen content were all significantly greater than reference values. 1. If the episodes are severe enough or frequent enough, there may be insufficient time for complete recovery between episodes, and acid-base values will deteriorate over time. a man of no importance: love who you love; imc graduate trader interview questions; gretchen bakery brownie recipe; north ga road conditions; cord gas interpretation calculator. Arch, Duerbeck N, Chaffin D, Seeds J. Khazin AF, Hon EH, Yeh SY. May contain information that is not supported by performance and intended use claims of Radiometer's products. Cord-blood metabolic acidosis which is characterized by reduced blood pH and decreased base excess (i.e. Once terminal fetal bradycardia has begun, the umbilical venous blood flow does not reopen; therefore, the venous sample is usually a reasonable proxy for the infant's acid-base status prior to terminal fetal bradycardia. Pediatr Res 1987;22:557-66. The intrapartum acid-base status, the status of the oxygen and other gases in the fetus and the umbilical cord after birth is important in establishing the link between events before and shortly after delivery. The base deficit is calculated using measured blood levels for acid (pH), dissolved carbon dioxide gas (PCO2), and bicarbonate HCO. Draw your tic tac toe . 1. The slower the circulation is through the placenta, the greater the amount of oxygen diffusion from mother to fetus, and the higher the PO2 in the umbilical vein. Delay in clamping by as little as 45 seconds after birth results in significant change in acid-base parameters [13-15]; the longer the delay, the greater is the change [16, 17]. Volume expansion is encouraged as part of advanced neonatal resuscitation if more basic care does not result in the desired improvement. 3. This smartphone app focuses on the preanalytical phase of blood gas testing and what operators can do to avoid errors. The change is a progressive decrease in pH and base excess, and increase in, The lack of consensus on this issue among national expert bodies is reflected in obstetric practice around the world; some obstetric units having a selective policy, whilst others are routinely performing cord blood gas analysis at all births. Blechner JN. The capillaries will then deliver the blood to the placenta's main artery where it is finally transferred to the baby. Although widened pH differences are almost always associated with cord occlusion with terminal fetal bradycardia, rarely the pH difference falls within the normal range, 0.04 0.10. We serve the following localities: Baltimore; Prince George's County including Bowie, Laurel, Landover, Hyattsville; Anne Arundel County including Glen Burnie; Baltimore County including Cockeysville, Glyndon, Hunt Valley, Jacksonville, Lutherville-Timonium, Owings Mills, Parkville, Reisterstown. a) Contamination of the arterial sample with an air bubble resulting . 2016, Medications. Loma Linda Publishing Company | 11175 Campus Street, Coleman Pavilion #11121, Loma Linda, CA 92354 USA | 1-302-313-9984 |, https://doi.org/10.51362/neonatology.today/20201115115457, None to many minutes (depending on timing of delivery). In recent years there has been increasing acceptance of the notion that delaying cord clamping by 2-3 minutes after birth is beneficial to the baby because of the placental blood transfusion it permits. Analyzing cord blood gas levels is often the best indicator of hypoxia or ischemia during the delivery period. A limited number of studies [29-32] have been conducted to test this proposition and thereby validate the clinical use of cord-blood lactate measurement. NCCLS document H11-A4. Details about pH pH=pK + log (HCO 3 /H 2 CO 3) (Henderson-Hasselbach euqation) pK=constant, it is the pH value at which H 2 CO 3 Check out our full ABG interpretation guide if you want to learn more. There is no general agreement on the definition of a widened base deficit difference. In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. In general, however, metabolic acidosis is associated with more adverse outcomes. Very important update. This is important because there is little consensus on which of several algorithms should be used for this calculation. (14,15) This results in progressive deterioration of the blood gas in the umbilical arteries as long as blood continues to flow in these vessels. Edelstone DI, Peticca BB, Goldblum LJ. If is preferable to obtain both arterial and venous umbilical cord blood samples for analysis. For pH, the A-V difference should be >0.02 pH units, and for pCO2 the A-V difference should be >0.5 kPa (3.75 mmHg). Of course, terminal cord occlusion does not preclude severe repetitive cord occlusion with insufficient time for even the PCO2 to fully recover between occlusive episodes or a preexisting or simultaneous occurrence of uteroplacental insufficiency. Your body normally tightly regulates the amount of oxygen and carbon dioxide in your . Clamping the umbilical cord is standard procedure when a baby is born. The applicability of cord blood gas analysis is an unresolved controversy that will be addressed: should cord blood gas analysis be reserved for defined high-risk deliveries or should it, as some advise, be more universally applied at all hospital births? It is also important to get accurate results. However, there is an apparent consensus among those who have studied the issue that measurement of cord-blood lactate measurement has potential that should be further investigated. Immediately after birth, by umbilical cord blood sampling. The validation of paired (arterial and venous) samples is based on minimum arterio-venous (A-V) differences for pH and pCO2 experimentally determined by Westgate et al [2]. Although the quality and reliability of the blood gas instruments have improved dramatically, constant vigilance still is required and mandated to ensure accurate and precise results. Acidosis usually presents itself as decreased blood pH and increased base deficit. Waiting even 45 seconds will skew the results due to chemicals changing in the artery. Umbilical cord blood gas analysis helps doctors can detect if the child suffered a birth injury during delivery. Then it can be seen that bicarbonate "falls," revealing the underlying . They should take the time to examine the process of taking blood cord gas samples and identify any possible technical errors that make the results invalid. However, a diagnosis of HIE depends in part on demonstrating significant cord-blood metabolic acidosis, and a normal arterial cord-blood pH and base excess result usually excludes the possibility of perinatal asphyxia, and thereby that any neurological signs and symptoms (including cerebral palsy) exhibited by the neonate is due to HIE. Acta Obstrica Gynecol Scand 2012; 91: 574-79. The entire team from the intake Samantha to the lawyer himself (Ron Miller) has been really approachable. Normal arterial blood cord gases values in a full-term newborn: Normal blood cord gases levels in a preterm newborn: All values are 1 standard deviation. The key point for parents to know is that pH and BE/BD are the main values examined by the medical team.. If cord occlusion occurs intermittently prior to a terminal cord occlusion and bradycardia, as is usually the case, any respiratory or metabolic acidosis in the fetus will likely recover completely between episodes. Ron even fought to reduce how much I owed in medical bills so I could get an even larger settlement. Umbilical cord O 2 and CO 2 Fetal cord gas values result from the rapid transfer of gases and the slow clearance of acid across the placenta. Age. Calculate Anion Gap. Many children with troubling cord blood gas and APGAR results and have no long-term physical or cognitive deficits. There is currently a plague of 'venous' blood gases (VBG) in clinical practice. First, the A-V difference of lactate in cord blood has not been sufficiently clearly defined, so there is no way of reliably confirming that a lactate result relates to cord arterial blood. (16). When our birth injury lawyers are discussing a new case that has come into our office, one of the first questions is about the child's cord blood gas values. The umbilical vein is more easily compressed than the umbilical arteries because it has a thinner muscular wall, and the mean blood pressure in the vein (5) is lower than that in the arteries (6) by a factor of approximately ten. Because of increasing occluding forces, or as fetal blood pressure begins to falter secondary to fetal hypovolemia and cardiac hypoxia, the fetus' ability to continue umbilical artery blood flow will end. Haruta M, Funato T, Sumida T, Shinkai T. The influence of oxygen inhalation for 30 to 60 minutes on fetal oxygenation. Measurements of umbilical cord blood gases may be affected by several factors related to the method of sampling, storage, and assessment, and therefore there potentially a wide variation in accuracy. WbmedCentral. Umbilical-cord acidemia may indicate perinatal asphyxia and places a neonate at increased risk for hypoxic ischemic encephalopathy (HIE). However, because lactic acid crosses the placenta relatively poorly, a significantly greater base deficit in arterial cord blood indicates the presence of umbilical vein occlusion with at least some interval of partially restored umbilical arterial blood flow. LL . You perform an ABG, which reveals the following results: PaO2: 7.0 kPa (11-13 kPa) || 52.5 mmHg (82.5 - 97.5 mmHg) pH: 7.29 (7.35 - 7.45) As far as I am aware, cord occlusion with terminal bradycardia has never been studied separately as a cause of neonatal asphyxia. The severe intrapartum hypoxia that this degree of cord metabolic acidosis reflects is associated with increased risk of hypoxic brain-cell injury and associated hypoxic-ischemic encephalopathy (HIE). Both are used to determine the acidity level in the umbilical cord.