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A Reassessment and Review of the Literature

Sherry E. Courtney, MD; Kaye R. Weber, RRT; Lee A. Breakie, RRT; Seth W. Malin, MD; Charles V. Bender, MD; Shumei Guo, PhD; Roger M. Siervogel, PhD

Am J Dis Child. 1990;144(2):168-172.

Abstract
• Heel puncture capillary blood gas (CBG) measurements continue to be used in neonates for estimating arterial blood gas values. Review of the literature reveals general agreement that CBG Po₂ values are of little use in predicting arterial Po₂ and that CBG pH values are reliable predictors of arterial pH; opinion varies regarding CBG Pco₂. We conducted a two-part study comparing postductal arterial and CBG values. First, 50 infants were studied, each only once. All infants had umbilical arterial catheters in place. Blood was obtained simultaneously from the umbilical artery catheter and the warmed heels. Results demonstrated poor predictability of arterial values from CBG pH and Pco₂ as well as for Po₂. Second, to determine if variation both within and among individuals was similar, repeated measurements were made in 27 additional infants comparable to the first group. We obtained 3 to 28 simultaneous postductal arterial and CBG samples from each infant. A random-effects nested analysis of variance indicated that for pH, variation was largely the result of between-subject or within-subject replicates effects, while for Po₂ and Pco₂, most variation was explained by differences between the two techniques (umbilical artery catheter vs CBG). The results indicate that CBG measurements do not accurately predict arterial values in neonates. Extreme caution should be used when management decisions are based on CBG values.

(AJDC. 1990;144:168-172)

Author Affiliations
From the Division of Newborn Medicine (Drs Courtney, Malin, and Bender) and the Department of Respiratory Therapy (Ms Weber and Mr Breakie), Children's Medical Center, and the Department of Pediatrics, Wright State University (Drs Courtney, Malin, Bender, Guo, and Siervogel), Dayton, Ohio.

Footnotes
Accepted for publication July 31, 1989.

Presented in part at the Annual Meeting of the Society for Pediatric Research, Washington, DC, May 5, 1988.

Reprint requests to Division of Newborn Medicine, Children's Medical Center, One Children's Plaza, Dayton, OH 45404 (Dr Courtney).

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