59 - Copeptin is a marker of physiological stress at birth

Publication Number: 1052.59

Michelle Foldschak Turesson, Lund University, Malmö, Skane Lan, Sweden; Ola Andersson, Lund University, Halmstad, Hallands Lan, Sweden; Johan Svensson, Skåne University Hospital, Malmö, Skane Lan, Sweden; Karolina Nilsson, Lund University, Lund, Skane Lan, Sweden; Lucas R.. Belfiore, Dep pediatrics, Institute of Clinical Sciences Lund, Lund University, Lund, Skane Lan, Sweden

Background: A reliable stress marker is needed to understand birth asphyxia and neonatal stress. Copeptin, a stable marker of arginine vasopressin release, correlates with neonatal stress and varies by delivery mode. Ongoing research has investigated cord blood copeptin correlation to Apgar score, cord blood acid-base balance, perinatal neonatal asphyxia and further disease states, showing potential for clinical use. Baseline values in healthy term neonates require further study.

Objective: To compare cord blood copeptin levels in healthy, term neonates born following elective cesarean section (eCS) and vaginal birth after uncomplicated pregnancy.

Design/Methods: Couples at Skåne University Hospital in Sweden were recruited. Healthy mothers with uncomplicated, singleton pregnancies were included; exclusions included maternal treatment for major disease or neonatal complications requiring resuscitation. Venous cord blood samples were collected from neonates born via elective cesarean section or vaginally. Copeptin levels were analyzed. Parametric and non-parametric data were compared using Student's t-test and Mann-Whitney U test respectively.

Results: Cord blood samples were collected from 42 neonates: 25 neonates born by eCS and 17 born vaginally were included in the study. One neonate from the eCS group was excluded due to resuscitation initiated after collection of cord blood. Groups differed significantly in gestational age, mother's age, cord clamping time and, cord blood acid-base status (Table 1). Copeptin levels differed markedly by delivery mode, median 6.2 (interquartile range 5.0-9.6) pmol/L in eCS vs. 798.4 (interquartile range 483.8-1649.2) pmol/L in vaginal delivery), p< 0.001 (Figure 1). Copeptin correlated strongly and inversely with cord arterial pH (Spearman ρ = −0.772, p< 0.001) and showed weak correlation with 1-minute Apgar score (ρ = −0.273, p=0.084).

Conclusion(s): Delivery mode significantly influences cord blood copeptin levels in healthy, term neonates. These findings provide preliminary reference values stratified by delivery method, contributing to the foundation for using copeptin as a quantitative measure of neonatal stress and hypoxic exposure.

Table 1
Descriptive statistics of the patient groups. p values are products of Student's T test or Mann Whitney U test, depending on type of data. SD = standard deviation. IQR = interquartile range. kPa = kilopascal. mmol/L = millimoles per liter. *: p value <0.05. **: p value <0.005

Figure 1
Boxplot of Copeptin levels depending on Birth method