{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:48:33Z","timestamp":1747198113549,"version":"3.40.5"},"reference-count":40,"publisher":"Walter de Gruyter GmbH","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2022-0772_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Umbilical cord blood gases (UBG) may be a critical element in the assessment of a depressed newborn infant but in some cases the arterial or venous UBG source is uncertain making clinical and\/or medical-legal interpretation difficult. Objective: to estimate the probability of an arterial (ProbAS) or venous (ProbVS) UBG source depending on blood gas parameters in acidemic cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2022-0772_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 56,703 pairs of concomitant arterial and venous (CAV) UBG results assayed over an 8.8-year period were analyzed. Specimen pairs with preanalytical issues, duplicate source, or physiologically out-of-range or uninterpretable results were excluded. The 3,579 CAV-UBGs with an arterial and venous pH 6.70 to 7.25 were analyzed. Generalized additive model (gam)-based binomial logistic regressions were used to determine the\u00a0ProbAS and ProbVS according to the blood gas parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2022-0772_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The relative differences between arterial and venous medians were: pO<jats:sub>2<\/jats:sub> \u201247%, pCO<jats:sub>2<\/jats:sub> 22%, pH\u00a0\u221211%, and BD 4%. Below a median of 2.4\u00a0kPa, the lower the pO<jats:sub>2<\/jats:sub>, the higher the ProbAS. Above this value, the higher the pO<jats:sub>2<\/jats:sub>, the lower the ProbAS. An Excel worksheet is provided to calculate ProbAS and ProbVS from the regression model for different combinations of pH, pCO<jats:sub>2<\/jats:sub>, and pO<jats:sub>2<\/jats:sub> values. Considering ProbAS and ProbVS above a cutoff 0.8, the model correctly identified the source in 56% of cases while 41% were indeterminant and 3% were erroneous.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2022-0772_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The probability of an arterial or venous source of an umbilical blood gas can be estimated based on the pH, pCO<jats:sub>2<\/jats:sub>, and pO<jats:sub>2<\/jats:sub> in most acidemic specimens.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2022-0772","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T21:21:25Z","timestamp":1665436885000},"page":"112-122","source":"Crossref","is-referenced-by-count":1,"title":["Umbilical cord blood gases: probability of arterial or venous source in acidemia"],"prefix":"10.1515","volume":"61","author":[{"given":"Denis","family":"Monneret","sequence":"first","affiliation":[{"name":"Service de Biochimie et Biologie Mol\u00e9culaire, Laboratoire de Biologie M\u00e9dicale Multi-Sites (LBMMS), Hospices Civils de Lyon (HCL) , Lyon , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4485-0528","authenticated-orcid":false,"given":"Robert L.","family":"Stavis","sequence":"additional","affiliation":[{"name":"Grand Rounds Software, LLC , Bryn Mawr , PA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2022,10,11]]},"reference":[{"key":"2022121406564045405_j_cclm-2022-0772_ref_001","unstructured":"Neonatal Encephalopathy and Neurologic, Outcome. Report of the American College of Obstetricians and Gynecologists\u2019 task force on neonatal encephalopathy, 2nd ed. Washington, DC: ACOG, AAP; 2014. Reaffirmed 2019. Available from: https:\/\/www.acog.org\/-\/media\/project\/acog\/acogorg\/clinical\/files\/task-force-report\/articles\/2014\/neonatal-encephalopathy-and-neurologic-outcome.pdf [Accessed 16 Jul 2022]."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_002","doi-asserted-by":"crossref","unstructured":"Ross, MG. Forensic analysis of umbilical and newborn blood gas values for infants at risk of cerebral palsy. J Clin Med 2021;10:1676. https:\/\/doi.org\/10.3390\/jcm10081676.","DOI":"10.3390\/jcm10081676"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_003","doi-asserted-by":"crossref","unstructured":"Ross, MG. Threshold of metabolic acidosis associated with newborn cerebral palsy: medical legal implications. Am J Obstet Gynecol 2019;220:348\u201353. https:\/\/doi.org\/10.1016\/j.ajog.2018.11.1107.","DOI":"10.1016\/j.ajog.2018.11.1107"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_004","doi-asserted-by":"crossref","unstructured":"Cantu, J, Szychowski, JM, Li, X, Biggio, J, Edwards, RK, Andrews, W, et al.. Predicting fetal acidemia using umbilical venous cord gas parameters. Obstet Gynecol 2014;124:926\u201332. https:\/\/doi.org\/10.1097\/aog.0000000000000517.","DOI":"10.1097\/AOG.0000000000000517"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_005","doi-asserted-by":"crossref","unstructured":"Swanson, K, Whelan, AR, Grobman, WA, Miller, ES. Can venous cord gas values predict fetal acidemia? Am J Obstet Gynecol 2017;217:364.e1\u2013364.e5. https:\/\/doi.org\/10.1016\/j.ajog.2017.05.047.","DOI":"10.1016\/j.ajog.2017.05.047"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_006","doi-asserted-by":"crossref","unstructured":"Johnson, JW, Richards, DS. The etiology of fetal acidosis as determined by umbilical cord acid-base studies. Am J Obstet Gynecol 1997;177:274\u201382. https:\/\/doi.org\/10.1016\/s0002-9378(97)70187-x.","DOI":"10.1016\/S0002-9378(97)70187-X"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_007","doi-asserted-by":"crossref","unstructured":"Riley, RJ, Johnson, JWC. Collecting and analyzing cord blood gases. Clin Obstet Gynecol 1993;36:13\u201323. https:\/\/doi.org\/10.1097\/00003081-199303000-00005.","DOI":"10.1097\/00003081-199303000-00005"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_008","doi-asserted-by":"crossref","unstructured":"Martin, GC, Green, RS, Holzman, IR. Acidosis in newborns with nuchal cords and normal Apgar scores. J Perinatol 2005;25:162\u20135. https:\/\/doi.org\/10.1038\/sj.jp.7211238.","DOI":"10.1038\/sj.jp.7211238"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_009","doi-asserted-by":"crossref","unstructured":"Westgate, J, Garibaldi, JM, Greene, KR. Umbilical cord blood gas analysis at delivery: a time for quality data. Br J Obstet Gynaecol 1994;101:1054\u201363. https:\/\/doi.org\/10.1111\/j.1471-0528.1994.tb13581.x.","DOI":"10.1111\/j.1471-0528.1994.tb13581.x"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_010","doi-asserted-by":"crossref","unstructured":"Tong, S, Egan, V, Griffin, J, Wallace, EM. Cord blood sampling at delivery: do we need to always collect from both vessels? BJOG 2002;109:1175\u20137. https:\/\/doi.org\/10.1111\/j.1471-0528.2002.01072.x.","DOI":"10.1111\/j.1471-0528.2002.01072.x"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_011","doi-asserted-by":"crossref","unstructured":"White, CR, Doherty, DA, Henderson, JJ, Kohan, R, Newnham, JP, Pennell, CE. Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit. Aust N Z J Obstet Gynaecol 2010;50:318\u201328. https:\/\/doi.org\/10.1111\/j.1479-828x.2010.01192.x.","DOI":"10.1111\/j.1479-828X.2010.01192.x"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_012","doi-asserted-by":"crossref","unstructured":"Kro, GA, Yli, BM, Rasmussen, S, Nor\u00e8n, H, Amer-W\u00e5hlin, I, Saugstad, OD, et al.. A new tool for the validation of umbilical cord acid-base data. BJOG 2010;117:1544\u201352. https:\/\/doi.org\/10.1111\/j.1471-0528.2010.02711.x.","DOI":"10.1111\/j.1471-0528.2010.02711.x"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_013","doi-asserted-by":"crossref","unstructured":"Monneret, D, Desmurs, L, Zaepfel, S, Chardon, L, Doret-Dion, M, Cartier, R. Reference percentiles for paired arterial and venous umbilical cord gases: an indirect nonparametric approach. Clin Biochem 2019;67:40\u20137. https:\/\/doi.org\/10.1016\/j.clinbiochem.2019.02.014.","DOI":"10.1016\/j.clinbiochem.2019.02.014"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_014","doi-asserted-by":"crossref","unstructured":"Low, JA, Panagiotopoulos, C, Derrick, EJ. Newborn complications after intrapartum asphyxia with metabolic acidosis in the term fetus. Am J Obstet Gynecol 1994;170:1081\u20137. https:\/\/doi.org\/10.1016\/s0002-9378(94)70101-6.","DOI":"10.1016\/S0002-9378(94)70101-6"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_015","doi-asserted-by":"crossref","unstructured":"Yeomans, ER, Hauth, JC, Gilstrap, LCIII, Strickland, DM. Umbilical cord pH, pCO2, and bicarbonate following uncomplicated term vaginal deliveries. Am J Obstet Gynecol 1985;51:798\u2013800. https:\/\/doi.org\/10.1016\/0002-9378(85)90523-x.","DOI":"10.1016\/0002-9378(85)90523-X"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_016","doi-asserted-by":"crossref","unstructured":"Thorp, JA, Sampson, JE, Parisi, VM, Creasy, RK. Routine umbilical cord blood gas determinations? Am J Obstet Gynecol 1989;161:600\u20135. https:\/\/doi.org\/10.1016\/0002-9378(89)90362-1.","DOI":"10.1016\/0002-9378(89)90362-1"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_017","unstructured":"Dickinson, JE, Eriksen, NL, Meyer, BA, Parisi, VM. The effect of preterm birth on umbilical cord blood gases. Obstet Gynecol 1992;79:575\u20138."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_018","doi-asserted-by":"crossref","unstructured":"Helwig, JT, Parer, JT, Kilpatrick, SJ, Laros, RK. Umbilical cord blood acid-base state; what is normal? Am J Obstet Gynecol 1996;174:1807\u201314. https:\/\/doi.org\/10.1016\/s0002-9378(96)70214-4.","DOI":"10.1016\/S0002-9378(96)70214-4"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_019","doi-asserted-by":"crossref","unstructured":"Kotaska, K, Urinovska, R, Klapkova, E, Prusa, R, Rob, L, Binder, T. Re-evaluation of cord blood arterial and venous reference ranges for pH, pO2, pCO2, according to spontaneous or Cesarean delivery. J Clin Lab Anal 2010;24:300\u20134. https:\/\/doi.org\/10.1002\/jcla.20405.","DOI":"10.1002\/jcla.20405"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_020","unstructured":"Reference manual for ABL800 FLEX series. Denmark: Radiometer Medical ApS; 2004. Available from: https:\/\/www.manualslib.com\/manual\/1220915\/Radiometer-Abl800-Flex.html?page=164#manual [Accessed 9 Apr 2022]."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_021","unstructured":"Wilson, SJ, Silverman, F, Young, BK. Fetal blood analysis. II. Effect of delayed assay on pH and lactate. Diagn Gynecol Obstet 1982;4:93\u20136."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_022","doi-asserted-by":"crossref","unstructured":"Hubert, M, Van der Veeken, S. Outlier detection for skewed data. J Chemometr 2008;22:235\u201346. https:\/\/doi.org\/10.1002\/cem.1123.","DOI":"10.1002\/cem.1123"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_023","unstructured":"Knowles, TP, Mullin, RA, Hunter, JA, Douce, FH. Effects of syringe material, sample storage time, and temperature on blood gases and oxygen saturation in arterialized human blood samples. Respir Care 2006;51:732\u20136."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_024","doi-asserted-by":"crossref","unstructured":"Duki\u0107, L, Kop\u010dinovi\u0107, LM, Doroti\u0107, A, Bar\u0161i\u0107, I. Blood gas testing and related measurements: national recommendations on behalf of the Croatian Society of Medical biochemistry and Laboratory Medicine. Biochem Med 2016;26:318\u201336. https:\/\/doi.org\/10.11613\/bm.2016.036.","DOI":"10.11613\/BM.2016.036"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_025","doi-asserted-by":"crossref","unstructured":"Matar, G, Poggi, B, Meley, R, Bon, C, Chardon, L, Chikh, K, et al.. Uncertainty in measurement for 43 biochemistry, immunoassay, and hemostasis routine analytes evaluated by a method using only external quality assessment data. Clin Chem Lab Med 2015;53:1725\u201336. https:\/\/doi.org\/10.1515\/cclm-2014-0942.","DOI":"10.1515\/cclm-2014-0942"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_026","unstructured":"Wood, SN. Generalized additive models: an introduction with R, 2nd ed. New York: Chapman and Hall\/CRC Press; 2017."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_027","unstructured":"Wood, SN. \u2018mgcv\u2019: Mixed GAM computation vehicle with automatic smoothness estimation. R package version 1.8-40; 2022. Available from: https:\/\/cran.r-project.org\/web\/packages\/mgcv\/mgcv.pdf [Accessed 16 Apr 2022]."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_028","doi-asserted-by":"crossref","unstructured":"Wood, SN. Low rank scale invariant tensor product smooths for generalized additive mixed models. Biometrics 2006;62:1025\u201336. https:\/\/doi.org\/10.1111\/j.1541-0420.2006.00574.x.","DOI":"10.1111\/j.1541-0420.2006.00574.x"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_029","unstructured":"Wickham, H. ggplot2: Elegant graphics for data analysis. New York: Springer-Verlag; 2016. ISBN 978-3-319-24277-4. Available from: https:\/\/ggplot2.tidyverse.org [Accessed 16 Jul 2022]."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_030","unstructured":"Simpson, G.: Graceful ggplot-Based Graphics and Other Functions for GAMs Fitted using mgcv. R package version 0.7.3; 2022. Available from: https:\/\/gavinsimpson.github.io\/gratia\/ [Accessed 16 Jul 2022]."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_031","unstructured":"van Rij, J, Wieling, M, Baayen, R, van Rijn, H. itsadug: interpreting time series and autocorrelated data using GAMMs. R package version 2.4.1; 2022. Available from: https:\/\/cran.r-project.org\/web\/packages\/itsadug\/itsadug.pdf [Accessed 16 Jul 2022]."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_032","unstructured":"Wang, Y, Zhao, S. Vascular biology of the placenta. San Rafael (CA): Morgan & Claypool Life Sciences; 2010. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53247\/ [Accessed 16 Jul 2022]."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_033","unstructured":"Wentworth, P. Some anomalies of the foetal vessels of the human placenta. J Anat 1965;99:273\u201382."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_034","doi-asserted-by":"crossref","unstructured":"Huisjes, HJ, Aarnoudse, JG. Arterial or venous umbilical pH as a measure of neonatal morbidity? Early Hum Dev 1979;3:155\u201361. https:\/\/doi.org\/10.1016\/0378-3782(79)90004-5.","DOI":"10.1016\/0378-3782(79)90004-5"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_035","doi-asserted-by":"crossref","unstructured":"Armstrong, L, Stenson, BJ. Use of umbilical cord blood gas analysis in the assessment of the newborn. Arch Dis Child Fetal Neonatal Ed 2007;92:F430\u20134. https:\/\/doi.org\/10.1136\/adc.2006.099846.","DOI":"10.1136\/adc.2006.099846"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_036","unstructured":"Pomerance, JJ. Interpreting umbilical cord blood gases, 2nd ed. Los Angeles, California: BNMG Publishing Division; 2012."},{"key":"2022121406564045405_j_cclm-2022-0772_ref_037","doi-asserted-by":"crossref","unstructured":"ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 348, November 2006: umbilical cord blood gas and acid-base analysis. Obstet Gynecol 2006;108:1319\u201322. https:\/\/doi.org\/10.1097\/00006250-200611000-00058.","DOI":"10.1097\/00006250-200611000-00058"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_038","doi-asserted-by":"crossref","unstructured":"Leino, A, Kurvinen, K. Interchangeability of blood gas, electrolyte and metabolite results measured with point-of-care, blood gas and core laboratory analyzers. Clin Chem Lab Med 2011;49:1187\u201391. https:\/\/doi.org\/10.1515\/cclm.2011.185.","DOI":"10.1515\/CCLM.2011.185"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_039","doi-asserted-by":"crossref","unstructured":"Luukkonen, AA, Lehto, TM, Hedberg, PS, Vaskivuo, TE. Evaluation of a hand-held blood gas analyzer for rapid determination of blood gases, electrolytes and metabolites in intensive care setting. Clin Chem Lab Med 2016;54:585\u201394. https:\/\/doi.org\/10.1515\/cclm-2015-0592.","DOI":"10.1515\/cclm-2015-0592"},{"key":"2022121406564045405_j_cclm-2022-0772_ref_040","doi-asserted-by":"crossref","unstructured":"De Koninck, AS, De Decker, K, Van Bocxlaer, J, Meeus, P, Van Hoovels, L. Analytical performance evaluation of four cartridge-type blood gas analyzers. Clin Chem Lab Med 2012;50:1083\u201391. https:\/\/doi.org\/10.1515\/cclm-2011-0685.","DOI":"10.1515\/cclm-2011-0685"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/cclm-2022-0772\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/cclm-2022-0772\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T07:03:21Z","timestamp":1671001401000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/cclm-2022-0772\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,11]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,10,31]]},"published-print":{"date-parts":[[2023,1,27]]}},"alternative-id":["10.1515\/cclm-2022-0772"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2022-0772","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"type":"print","value":"1434-6621"},{"type":"electronic","value":"1437-4331"}],"subject":[],"published":{"date-parts":[[2022,10,11]]}}}