Can a single lactate value predict adverse outcome in critically ill newborn?

Abstract

OBJECTIVES: The aim of this study was to investigate the role of the lactic acidosis, as an early predictor of signifi cant consequences and/or a fatal outcome in term neonates after a perinatal asphyxia. BACKGROUND: Severe perinatal asphyxia can generate multiple organ dysfunction and neonatal mortality. METHODS: In routine clinical practice, after an admission to the Intensive Care Unit, lactate concentration was determined in capillary blood samples during the fi rst one to six hours after birth in 55 term newborns with the post-asphyxial hypoxic-ischemic encephalopathy. The control group consisted of 36 healthy term neonates randomly selected in the maternity ward at the Gynecology and Obstetrics Clinic. RESULTS: Signifi cantly higher concentrations of lactate (p < 0.0005) were observed in term neonates with post asphyctic syndrome (8.63 ± 4.43 mmol/L) if compared to the control group subjects (1.04 ± 0.36 mmol/L). The increase in lactate level > 8.7mmol/L with 80 % sensitivity and 82 % specifi city indicated the development of the hypoxic-ischemic encephalopathy stage II/III, while the lactate level > 9.95 mmol/L was a predictor of death, with 75 % sensitivity and 74.4 % specifi city. CONCLUSION: Determination of lactate concentrations in serum of term newborns associated with risk factors for the perinatal asphyxia is a useful tool in diagnosing metabolic disorders and ischemic damage, particularly severe clinical forms (Tab. 2, Fig. 3, Ref. 34). Text in PDF www.elis.sk.

Lactate and S100 protein as early biochemical indicators of birth neonatal asphyxia caused by intrauterine umbilical cord strangulation: a medicolegal view

“…These results were in line with some studies which found that serum lactate level was higher in hypoxic neonatal group than healthy one (Gasparović et al, 2012;Simovic et al, 2015). Also, the study of Chiang et al (2016) revealed that higher serum lactate in hypoxic neonates and higher level was found in grade III HIE.…”

Serum lactate level as a useful predictor of clinical outcome after surgery: an unfulfilled potential?

“…The different policies between hospitals and departments reflect the controversy regarding the usefulness of the blood sample (1). Lately, interesting papers about blood lactate level as a predictor of clinical outcomes have been published, but if we consider the whole literature scenario we do not have enough data to consider lactate a totally reliable prognostic index, or at least not in all the clinical settings (2)(3)(4)(5)(6)(7)(8). Lactic acid is normally considered a molecule with an excellent sensitivity for the cellular damage caused by anaerobiosis due to an oxygen debit during a shock status.…”

Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

“…25 In newborn infants with perinatal hypoxia, lactate levels >8.7 mmol/L were associated with hypoxicischemic encephalopathy (HIE) of grade $2. 21 In a prospectively managed cohort of patients with neonatal respiratory disease supported with ECLS, peak lactate >15 mmol/L was associated with the composite adverse outcome: death from any cause before 18-to 24-month follow-up or evidence of neurologic disability at 18 to 24 months. 23 Informed by studies revealing gradation of association with poor outcomes, we included lactate 3 to <5 mmol/L (nonsevere) and lactate $5 mmol/L (severe), in association with another abnormal criteria, for the definition of cardiovascular dysfunction in critically ill children.…”

“…Laboratory 19,20,[22][23][24] reported as maximum during a given time frame, 21 or expressed as clearance of lactate burden over time. 20 Studies have consistently revealed lactate <2 mmol/L to be an important negative predictor of mortality, whereas higher lactate levels (>3 mmol/L, >4 mmol/L, >5 mmol/L, >5.5 mmol/L, >10 mmol/ L, and >25 mmol/L) were associated with mortality, with a relatively linear relationship when multiple cutoffs were assessed in the same analysis.…”

“…20 Studies have consistently revealed lactate <2 mmol/L to be an important negative predictor of mortality, whereas higher lactate levels (>3 mmol/L, >4 mmol/L, >5 mmol/L, >5.5 mmol/L, >10 mmol/ L, and >25 mmol/L) were associated with mortality, with a relatively linear relationship when multiple cutoffs were assessed in the same analysis. 11,19,21,23 In children with suspected sepsis, lactate measurements >3 mmol/L and >4 mmol/L at PICU admission, respectively, were associated with septic shock diagnosis and hospital length of stay >10 days. 25 In newborn infants with perinatal hypoxia, lactate levels >8.7 mmol/L were associated with hypoxicischemic encephalopathy (HIE) of grade $2.…”