Authors’ conclusions: low arterial cord pH showed strong, consistent, and temporal association with clinically important neonatal outcomes that are biologically plausible. These data could justify the increased surveillance of infants born with a low cord pH.
Reviewers’ commentary: there is a clear relationship between fetal acidosis and perinatal asphyxia, this systematic review also shows that the association between low pHAU and neonatal morbidity and mortality is not limited to populations at risk. This finding reopens the debate on whether we should make cord pH at every birth. That depends on whether this test provides an appropriate balance of risks, costs and benefits. Considering that this test can be done safely during delivery at low price, the key question would be: do we need to make a close follow up of all infants with low pHAU even without perinatal asphyxia? In this case the main "cost" would be the effect of labelling and the false positives. In our opinion, the pHAU is a useful data if available at all births, but current studies suggest recommend only a close follow up at medium to long term of newborns with pHAU when it is associated with perinatal asphyxia.