• Grete A B Kro, Branka M Yli, Svein Rasmussen, Håkan Norèn, Isis Amer-Wåhlin, Karl G Rosén, Babill Stray-Pedersen, and Ola D Saugstad.
• Women and Children's Division, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. gbirke@ous-hf.no
• Acta Obstet Gynecol Scand. 2013 Jun 1; 92 (6): 662-70.

ObjectiveTo determine the association between 5-min Apgar score and umbilical cord artery carbon dioxide tension (pCO₂).DesignObservational study.SettingEuropean hospital labor wards.PopulationData from 36,432 newborns ≥36 gestational weeks were obtained from three sources: two trials of monitoring with fetal electrocardiogram (the Swedish randomized controlled trial and the European Union Fetal ECG trial) and Mölndal Hospital data. After validation of the acid-base values, 25,806 5-min Apgar scores were available for analysis.MethodsValidation of the umbilical cord acid-base values was performed to obtain reliable data. 5-min Apgar score was regressed against cord artery pCO₂ in a polynomial multilevel model.Main Outcome MeasuresFive-min Apgar score, umbilical cord pCO₂, pH, and base deficit.ResultsOverall, a higher cord artery pCO₂ was found to be associated with lower 5-min Apgar scores. However, among newborns with moderate acidemia, lower umbilical cord artery pCO₂ (≤median pCO₂ for the specific cord artery pH) was associated with lower 5-min Apgar scores, with a relative risk of 2.0 (95% confidence interval: 1.4-2.8) for 5-min Apgar scores 0-6.ConclusionsMetabolic acidosis affects the newborn's vitality more than respiratory acidosis. In addition, elevated levels of pCO₂ may be beneficial for fetuses with moderate acidemia, and thus cord artery pCO₂ is a factor that should be considered when assessing the compromised newborn.© 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

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