Predictive value of fetal scalp blood lactate concentration and pH as markers of neurologic disability

Krüger, K; Hallberg, Boubou; Blennow, Mats; Kublickas, Marius; Westgren, Magnus

doi:10.1016/s0002-9378(99)70083-9

Cited by 151 publications

(144 citation statements)

References 21 publications

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“…In the latter study, haemodynamic effects of the vasopressors were similar to those in the earlier study, but in addition, they found that phenylephrine was associated with higher values for fetal lactate [8]. This is relevant because there is evidence that fetal lactate may be a better predictor of severe neonatal morbidity than pH [10]. Therefore, a possible implication of these results for clinical practice is that some caution with the use of phenylephrine in emergency cases may be warranted.…”

Section: Discussionsupporting

confidence: 69%

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Kee

Khaw

Lau³

et al. 2008

Anaesthesia

109

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SummaryIn a randomised, double-blinded study, we compared boluses of phenylephrine 100 lg with ephedrine 10 mg for treating hypotension (systolic blood pressure < 100 mmHg) in 204 patients having non-elective Caesarean section under spinal anaesthesia. Umbilical arterial (UA) and venous (UV) pH and base excess were similar between groups. In the ephedrine group, UA lactate concentration was higher (median 2.6 [interquartile range 2.

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Section: Discussionsupporting

confidence: 69%

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Kee

Khaw

Lau³

et al. 2008

Anaesthesia

109

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“…The finding is consistent with the concept that high urinary lactate excretion soon after birth reflects high blood lactate level caused by perinatal ischemic hypoxia. [3][4][5] Several studies have been done in the past regarding the role of blood 3-5 or urinary 6,8 lactate level at birth in predicting outcomes of term infants with hypoxic ischemic encephalopathy. Huang's study 8 showed a good predictive value of urinary lactate to creatinine ratio for the development of hypoxic ischemic encephalopathy.…”

mentioning

confidence: 99%

“…The potential relationship between degree of fetal hypoxia, lactic acidosis, and neurodevelopmental outcome prompted several investigators to assess blood lactate as a measure of varying degrees of fetal hypoxia that may predict short-and long-term outcomes. [3][4][5] Because lactate is in part excreted through the kidney, measurement of urinary lactate may also reflect the blood lactate level and the degree of metabolic derangement as a result of hypoxia/ischemia. Ma et al 6 and Zuppi et al, 7 using ( 1 H) proton nuclear magnetic resonance spectroscopy, have shown that urinary lactate and creatinine can be measured and used clinically.…”

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confidence: 99%

Association between Urinary Lactate to Creatinine Ratio and Neurodevelopmental Outcome in Term Infants with Hypoxic-Ischemic Encephalopathy

Perritt

Shankaran

et al. 2008

The Journal of Pediatrics

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Objective-To assess the association between urinary lactate to creatinine ratio (ULCR) and neurodevelopmental outcome in term infants with hypoxic ischemic encephalopathy and examine the effect of hypothermia on the change in ULCR.Study design-Spot urine samples were collected in 58 term infants (28 hypothermia, 30 control subjects) with hypoxic ischemic encephalopathy. Urinary lactate and creatinine were measured by using 1 H nuclear magnetic resonance spectroscopy and expressed as ULCR. Survivors were examined at 18 months of age.Results-The ULCR was significantly higher in infants who died or had moderate/severe neurodevelopmental disability. Logistic regression analysis controlling for hypothermia and severity of encephalopathy confirmed the association (adjusted odds ratio, 5.52; 95% CI, 1.36, 22.42; P < . 02). Considerable overlap in ULCR was observed between infants with normal/mild disability and those who died or survived with moderate/severe disability. ULCR fell significantly between 6 and 24 hours and 48 and 72 hours of age for all infants. The magnitude of decline did not differ between hypothermia and control groups.Conclusions-High ULCR is associated with death or moderate/severe neurodevelopmental disability. Significant overlap in values between the normal/mild and moderate/severe disability groups limits predictive value of this measure. Whole-body hypothermia did not affect the decline in ULCR.Hypoxic-ischemic encephalopathy is a serious morbidity in newborn infants with high mortality rate and a high rate of poor neurodevelopmental outcome among survivors. METHODSThis study involved a subset of term infants randomly assigned in a controlled trial conducted by the NICHD Neonatal Research Network to evaluate the efficacy and safety of whole-body hypothermia in term infants with hypoxic ischemic encephalopathy. This study was approved by the institutional review board in each site. The subjects and methods of the primary protocol have been published. 9 A set of predetermined criteria was used by trained investigators to establish the diagnosis and severity of hypoxic ischemic encephalopathy. Two hundred eight infants with hypoxic ischemic encephalopathy were enrolled in this trial. Of these infants, 58 were enrolled in the current study, 28 in the hypothermia group, and 30 in the control group.Collection of spot urine was initiated on study infants as soon as consents were obtained. The first urine was collected between 6 and 24 hours and repeated at 48 to 72 hours, using a bag placed over the perineum of girls and a test tube placed over the penis for boys. Urine was aspirated from the bag or test tube using a syringe connected to a catheter. Urine spilled on the diaper was also aspirated. Urine samples were stored at −20°C until shipment in dry ice to the central laboratory (Ralph B. Rogers MR Center, University of Texas-Southwestern Medical Center, Dallas, Texas) for assay.Samples were prepared for nuclear magnetic resonance (NMR) spectroscopy by thawing and removing a 550-μL aliquot...

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“…under non-steady stressed conditions) have shown that umbilical venous and arterial lactate concentrations as well as the umbilical venoarterial concentration difference correlate with Apgar scores both at 1= and 5= (8,9). In clinical studies performed at the time of spontaneous delivery, lactate concentrations have been shown to represent a much more reliable marker of fetal acidosis compared with pH measurements (10,11). However, difficulties in sample management have limited its widespread clinical application.…”

mentioning

confidence: 99%

Lactacidemia in Intrauterine Growth Restricted (IUGR) Pregnancies: Relationship to Clinical Severity, Oxygenation and Placental Weight

et al. 2006

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ABSTRACT:The aim of the study was to evaluate the impact of clinical severity and placental weight upon fetal lactacidemia in intrauterine growth restricted (IUGR) pregnancies. Seventy pregnancies complicated by IUGR were compared with 70 normal (appropriate for gestational age, AGA) pregnancies at the time of elective cesarean section. IUGR pregnancies were divided according to clinical severity in three groups: Group 1 had normal fetal heart rate (FHR) and normal pulsatility index of the umbilical artery (PI); Group 2 had normal FHR and abnormal PI; and Group 3 had abnormal FHR and PI. No cases with severe lactacidemia had placental weights Ն250 g. Forty-four fetuses had placental weight Ͻ250 g: Twenty-four had severe lactacidemia and all were Group 2 and 3, whereas 20 had normal umbilical artery lac (lactate) (and small placentas) regardless of the clinical severity. Gestational age, fetal and placental weights, F/P ratios, uv (umbilical vein) and ua lac and ua oxygen content and pH were significantly decreased in fetuses with small placentas and high lactate. There was a significant relationship between fetal and placental weight in AGA and IUGR. However, IUGR fetuses with placental weight Ն250 g exhibited an F/P ratio significantly lower than that in AGA fetuses suggesting that IUGR may be due to a reduction of placental function per gram of tissue. (Pediatr Res 59: 570-574, 2006) L actate represents the end product of anaerobic metabolism of glucose. However, many experimental as well as studies in human pregnancies both in vivo (1-3) and in vitro (4,5) have shown that lactate is produced within the placenta and delivered into both the maternal and umbilical circulation where it serves as source of carbon for fetal growth. This has been clearly demonstrated by studies in pregnant sheep where fetal utilization of lactate at term is three times higher than the umbilical uptake (approximately 4 mg/kg/min) in the welloxygenated fetus (6). The fetal liver is the organ with the highest lactate consumption and liver lactate uptake almost equals umbilical uptake: lactate is then used for oxidation and synthesis of fatty acid and glycogen (7). In human pregnancies, fetal lactate concentration is higher than maternal (2,3). Many clinical studies at the time of delivery (i.e. under non-steady stressed conditions) have shown that umbilical venous and arterial lactate concentrations as well as the umbilical venoarterial concentration difference correlate with Apgar scores both at 1= and 5= (8,9). In clinical studies performed at the time of spontaneous delivery, lactate concentrations have been shown to represent a much more reliable marker of fetal acidosis compared with pH measurements (10,11). However, difficulties in sample management have limited its widespread clinical application. Recently the characteristics of L-lactic acid transport across the human placental syncytiotrophoblast have been described (12,13) as has been done for human erythrocytes (14), hepatocytes (15), intestinal brush border membrane (16,17)...

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Predictive value of fetal scalp blood lactate concentration and pH as markers of neurologic disability

Cited by 151 publications

References 21 publications

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Association between Urinary Lactate to Creatinine Ratio and Neurodevelopmental Outcome in Term Infants with Hypoxic-Ischemic Encephalopathy

Lactacidemia in Intrauterine Growth Restricted (IUGR) Pregnancies: Relationship to Clinical Severity, Oxygenation and Placental Weight

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