Plasma D-lactate Levels in Necrotizing Enterocolitis in Premature Infants

Abstract

BackgroundD-Lactate is normally present in the blood of humans at nanomolar concentrations due to methylglyoxal metabolism; millimolar D-lactate concentrations can arise due to excess gastrointestinal microbial production.ObjectivesTo examine the levels of plasma D-lactate in the necrotizing enterocolitis in premature infants.Patients and Methods128 premature infants were divided into control (group I, n = 69), feeding intolerance (group II, n = 42) and NEC (group III, n = 27) groups. Plasma D-lactate levels were measured at the onset of feeding intolerance or NEC and at weeks 2-3 in control infants (group I) by ELISA. Data were analyzed using descriptive statistics, non-parametric tests and Student’s t-test.ResultsIn groups I, II, III, median birth weights were 1845.7 ± 267.5 g, 1913.1 ± 306.5 g, and 1898.4 ± 285.3 g, median gestational ages were 34.3 ± 1.7 weeks, 33.9 ± 2.2 weeks and 35.1 ± 2.6 weeks, ages of sampling were 12.3 ± 2.9 days, 14.6 ± 3.7 days and 15.1 ± 1.8 days, respectively. The differences of median birth weights, median gestational ages and ages of sampling were not statistically significant (P > 0.05). The plasma D-lactate levels in groups I, II, III were 3.6 ± 1.9 μg/mL, 12.7 ± 8.3 μg/mL, and 35.4 ± 29.1 μg/mL, respectively, group III had higher plasma D-lactate level than groups I, II, and the difference among these groups was significant (x2 = 21.6, P < 0.01).ConclusionsPlasma D-lactate significantly increased early in NEC. Plasma D-lactate levels were associated with extensive disease in NEC infants. Therefore, it could be used as a diagnosis indicator in the early stage of NEC.

Lactate and intestinal fatty acid binding protein as essential biomarkers in neonates with necrotizing enterocolitis: ultrasonographic and surgical considerations

“…19 Garcia et al 20 found that urinary lactate level increased in infants with NEC with increased enteric bacterial activity in those cases. Recently, Lei et al 21 examined levels of plasma lactate in premature infants affected by NEC, finding them to increase significantly early in direct proportion to the overall extent of intestinal disease, but sensitivity and specificity were not reported. In the current study, plasma lactate was found to be elevated among the included neonates with NEC when compared with the controls.…”

Urine NMR Metabolomics Profile of Preterm Infants With Necrotizing Enterocolitis Over the First Two Months of Life: A Pilot Longitudinal Case-Control Study

“…Lactate produced by human metabolism is primarily the levorotatory isomer L-lactate; conversely, D-lactate is prevalently produced by bacterial fermentation of undigested carbohydrates in the gastrointestinal tract, and only a small fraction of this isomer is endogenously formed from methylglyoxal through the glyoxalase system (Adeva-Andany et al, 2014). High levels of D-lactate have been found in the urine and plasma of preterm babies with NEC (Garcia et al, 1984;Lei et al, 2016); this finding suggests that D-lactate may be considered an index of increased enteric bacterial activity (Grishin et al, 2013). Although 1 H NMR is unable to distinguish the lactate enantiomers, we cannot rule out that the high abundance of lactate in the urine of infants with late-onset NEC may derive at least in part from the accumulation of D-lactate. The positive correlation between lactate and postnatal age in group 2 FI and in the subgroup late-onset NEC, together with the concomitant decrease in N-methylnicotinamide, seem to confirm an imbalance of the host−microbial metabolism in these infants.…”

Metabolomic signatures distinguish the impact of formula carbohydrates on disease outcome in a preterm piglet model of NEC

“…This pattern was intriguing and may signal hypoxic metabolism in the plasma of the host during NEC pathogenesis, whereas increased cecal lactate may be driven by fermentation of corn syrup solids by Lactobacillus as mentioned above. Lactic acidosis, especially the D-isomer produced by bacteria, has been reported in infants with NEC and in conditions of bacterial overgrowth with short-bowel syndrome [ 79 – 82 ]. D-lactic acidosis has been linked to encephalopathy and other toxicities [ 83 ].…”