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 significant 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 first 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: Significantly 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 % specificity 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 % specificity. 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.