Day 1 serum lactate values in preterm infants less than 32 weeks gestation.

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 7603873 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1076 (Electronic) Linking ISSN: 03406199 NLM ISO Abbreviation: Eur J Pediatr Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: Berlin, New York, Springer-Verlag.

Infant, Premature* ; Infant, Very Low Birth Weight* ; Neonatal Screening*; Acid-Base Imbalance/*diagnosis ; Intracranial Hemorrhages/*prevention & control ; Lactic Acid/*blood ; Leukomalacia, Periventricular/*prevention & control; Acid-Base Imbalance/blood ; Biomarkers ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intracranial Hemorrhages/blood ; Leukomalacia, Periventricular/blood ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Survival Analysis

Base deficit and serum lactate concentrations may be important prognostic indicators in preterm infants. We sought to (1) determine the relationship between day 1 serum lactate values and base deficit and (2) determine the relationship between day 1 biochemical parameters and adverse outcome in preterm infants <32 weeks. This was a retrospective study of all patients less than 32 weeks gestation admitted to neonatal intensive care unit over a 6-month period. All blood gases performed during the first 24 h post delivery were analysed. Adverse outcome was defined as death, severe (grade 3 or 4) intraventricular haemorrhage or periventricular leukomalaica on cranial ultrasonography. Patients were excluded if there was a known lethal malformation or cardiac defect. Seventy-two infants had a total of 473 lactate levels performed in the first 24 h. Mean (SD) gestational age was 29 (2.3) weeks, mean (SD) birth weight 1.28 (0.42) kg. Mean (SD) lactate values in first 6 h was 4.63 (3.69), at 12 h 3.08 (2.6), at 18 h 2.47 (2.68) and 2.08 (2.74) mmol/l at 24 h. There was a strong correlation between lactate values and base deficit values (R value 0.8, p < 0.01). Mean base deficit values at 6 h were 5.9 (4.5), at 12 h 3.8 (3.9), at 18 h 3.6 (3.1) and at 24 h 4.1 (3.8) mmol/l. A single lactate value greater than 5.6 mmol/l had a sensitivity of 100% and specificity of 85% of identifying adverse outcome. Persistently elevated or worsening lactates were associated with adverse outcome. There is a strong correlation between lactate values and base deficit on day 1 of life. Serial lactate measurements greater than 5.6 mmol/l predict adverse outcome and may aid the clinician in bedside decision making.

Acta Paediatr. 2002;91(1):17-9. (PMID: 11883813)
Pediatr Res. 1999 Mar;45(3):343-9. (PMID: 10088652)
Arch Dis Child Fetal Neonatal Ed. 1997 Jan;76(1):F15-20. (PMID: 9059180)
Semin Neonatol. 2001 Feb;6(1):85-95. (PMID: 11162288)
Biol Neonate. 2003;83(3):171-6. (PMID: 12660433)
Acta Paediatr. 2002;91(1):78-81. (PMID: 11883824)
Eur J Pediatr Surg. 2003 Feb;13(1):35-9. (PMID: 12664413)
J Pediatr. 1994 Nov;125(5 Pt 1):763-8. (PMID: 7965432)
Crit Care Med. 2004 Aug;32(8):1637-42. (PMID: 15286537)
Arch Dis Child Fetal Neonatal Ed. 2008 Sep;93(5):F368-71. (PMID: 18089627)
Acta Paediatr. 2000 Mar;89(3):320-3. (PMID: 10772280)
Arch Dis Child. 2004 Feb;89(2):176-80. (PMID: 14736638)
J Pediatr. 1992 Dec;121(6):951-5. (PMID: 1447665)
Arch Dis Child Fetal Neonatal Ed. 2009 Jul;94(4):F241-4. (PMID: 19174413)
J Pediatr. 1993 Apr;122(4):629-31. (PMID: 8463915)
Chest. 2003 May;123(5):1361-6. (PMID: 12740248)

0 (Biomarkers)
33X04XA5AT (Lactic Acid)

Date Created: 20091017 Date Completed: 20100726 Latest Revision: 20211020

20221213

10.1007/s00431-009-1085-y

19834738