I have a question regarding international codes. If a baby is born with low umbilical artery pH, but the Apgar score is normal, adapts well, pH/ BE/ lac normalizes, amniotic fluid is clear, and there is no multi-organ failure. Would you code it anyway P20.1 (fetal acidosis alone)

If the infant would be admitted to the NICU, we would probably use P20.9 or P20.1 depending on the symptoms (less or more, respectively).

However, if there is only acidosis in umbilical samples and no symptoms at all, and the infant goes with the parents to the well baby / maternity ward, we would probably just use Z00.1A for ”healthy newborn”. The example you describe sounds like such an infant :)

Just out of curiosity, do you have a pH-limit where you would always admit for observation?

Where I usually work we admit and observe children with umbilical cord pH <7. But when doing my rotation a baby with an ok APGAR at 5 and 10 minutes would go to the maternity ward with UA-pH 6,9 if no signs of distress.

You would feed, check glucose and do a follow up blood gas to monitor normalisation, but not have any closer observation for possible seizures. This could have to do with limited access to ward beds (e.g. staff) though,

Acidos without low apgar or need for resusc - at least those are not at risk of hypothermia

We don't admit for this reason but back in the days, "my professor" taught me to give buffer when BE was lower than -15 😬

PubMed

Low Apgar score and need for resuscitation increased the...

A low Apgar score of and/or a need for resuscitation is more relevant for identifying infants eligible for therapeutic hypothermia, compared to other A criteria. This knowledge could be used clinic...

We have our "inside" agreemets regarding the observation of the newborn. When the pH is <7,0 - monitoring in skin-to-skin contact, neonatologist check-up and repeating the analysis after 2 hours if clinical pic is ok. When the pH is < than 7,1 - monitoring, repeating the analysis and neonatologist if needed.

Some of my colleagues discuss about ICD code in those cases and document it as fetal distress. Im not sure its necessary...