RISK FACTORS FOR NEONATAL

DEATH IN NEWBORN WITH SEVERE

ACIDOSIS (LETHAL pH)

Philip Sinaga, M Sholeh Kosim

Departement of Pediatric,
Faculty of Medical, Diponegoro University
Dr. Kariadi Hospital, Semarang
 BACKGROUND

 Severe acidosis correlates with the incidence of multiple organ

failure (neurologic, cardiac, respiratory, renal)  always lead to
death

 Severe acidosis : arterial pH < 7.00

 May occur in neonates with prematurity, preeclampsia /

eclampsia, prolonged labour, caesarean section, hypothermia,
asphyxia, sepsis, etc.

 There was still a few study about risk factors of neonatal severe
acidosis

Ricki F, et al. Influence of Acidosis, Hypoxemia, and Hypotension on Neurodevelopmental Outcome in Very Low
Birth Weight Infants. Pediatrics 1995;95;238
OBJECTIVES
To determine risk factors for neonatal death of
severe acidosis in Dr. Kariadi General Hospital
METHODS
 Case control study
 Data collected from medical records in
NICU
Dr. Kariadi General Hospital
 January - December 2015
 Divided into 2 groups
• Case group  severe acidosis (pH<7,0)
• Control group  mild-moderate acidosis
(pH 7,0-7,2)
 Analyzed by using logistic regression
analysis
• Risk factors studied :
• Maternal age
• Method of Delivery
• Gestational Age
• History of PROM
• History of Eclampsia/PE

Due to the difficulties of finding severe acidosis/lethal pH case

with complete medical record, we found 9 cases as case and
• Birthweight
took 18 cases as control
• Asphyxia
• Congenital deformity
• Surgical procedure
 RESULT
Table 1 Risk factors of mortality in neonatal severe acidosis

Variables OR 95% CI P
Maternal Age 2,46 0,18 – 33,63 0,50
Low Birthweight 5,16 1,02 – 26,07 0,047
Congenital Deformity 111,04 1,734 – 109,54 0,026
Surgical Procedure 8,06 0,35 – 183,91 0,19

 Sex, history of PROM, asphyxia, methods of delivery, maternal age,

gestational age, history of eclampsia/preeclampsia factors are not
significantly associated with neonatal morbidity with severe acidosis

 Logistic regression analysis revealed low birthweight & congenital

deformities as the risk factors for neonatal death with severe acidosis
 DISCUSSION

• Low birthweigth not only may be related to the

incidence of severe acidosis but also directly
associated with neonatal deaths
• Congenital deformity/anomaly might be attribute to
some metabolic anomality  need further study
• Limitation :
– Small number of subjects
– Bias (infection, length of care, dietary regimen, etc.)

•De Franco S, Esposito S, Rossaro D, Bona G, Ferrero F. Risk factors in newborns with severe acidosis at birth.
Panminerva Med 2007;49:17–9
•Goldaber KB, Gilstrap LC III, Leveno KJ. Pathologic fetal acidemia. Obstet Gynecol. 1991; 78: 1103-
 CONCLUSION

Low Birthweight and Congenital Deformity were

the risk factors for neonatal death in newborn with
severe acidosis
Thank You