APGAR score and umbilical cord blood levels of Lactate and Creatinine in Perinatal asphyxia

Objective: APGAR score and umbilical cord blood levels of Lactate and Creatinine in Perinatal asphyxia D esign: Descriptive cross sectional study. Setting: Labour room of Medical College Hospital, Thrissur , Kerala Subjects: 128 babies born during two months period (April May 2008 were included in the study. Outcome measures: Well being of the new born assessed by the clinical criterion, Apgar score and severity of asphyxia in the new born assessed by cord blood lactate and creatinine. Results: Reference limits and clinical decision limits of lactate (12- 76 mg%; 27mg %) and creatinine (0.60-1.4 mg%; 0.81 mg %) were found out. The clinical decision limit of lactate obtained in the study (27 mg %) was found to be significantly associated with perinatal asphyxia diagnosed by Apgar score. Sensitivity and specificity of cord blood lactate at the cut off value of 27 mg% is 68% and 60 % respectively (AUC = 0.679 P =0.0001) Where as for creatinine the clinical decision limit obtained was 0.81 and at this level +ve LR and -ve LR were 1.34 and 0.59 respectively. The area under ROC curve (AUC) was 0.576 but it did not the achieve statistical significance (P = 0.1336) Conclusion: Cord blood lactate assay of new born will help to evaluate the severity of anoxia and it will be useful to nullify any subjective errors produced during the clinical assessment of newborn babies by Apgar score.