Document Detail

Postnatal lactate as an early predictor of short-term outcome after intrapartum asphyxia.
MedLine Citation:
PMID:  14726932     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To compare the predictive value of pH, base deficit and lactate for the occurrence of moderate-to-severe hypoxic ischaemic encephalopathy (HIE) and systemic complications of asphyxia in term infants with intrapartum asphyxia. STUDY DESIGN: We retrospectively reviewed the records of 61 full-term neonates (> or =37 weeks gestation) suspected of having suffered from a significant degree of intrapartum asphyxia from a period of January 1997 to December 2001. The clinical signs of HIE, if any, were categorized using Sarnat and Sarnat classification as mild (stage 1), moderate (stage 2) or severe (stage 3). Base deficit, pH and plasma lactate levels were measured from indwelling arterial catheters within 1 hour after birth and thereafter alongwith every blood gas measurement. The results were correlated with the subsequent presence or absence of moderate-to-severe HIE by computing receiver operating characteristic curves. RESULTS: The initial lactate levels were significantly higher (p=0.001) in neonates with moderate-to-severe HIE (mean+/-SD=11.09+/-4.6) as compared to those with mild or no HIE (mean+/-SD=7.1+/-4.7). Also, the lactate levels took longer to normalize in these babies. A plasma lactate concentration >7.5+/-mmol/l was associated with moderate-or-severe HIE with a sensitivity of 94% and specificity of 67%. The sensitivity and negative predictive value of lactate was greater than that of the pH or base deficit. CONCLUSIONS: The highest recorded lactate level in the first hour of life and serial measurements of lactate are important predictors of moderate-to-severe HIE.
Sachin Shah; Mark Tracy; John Smyth
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  24     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-16     Completed Date:  2004-05-11     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-20     Citation Subset:  IM    
Neonatal Intensive Care Unit, Nepean Hospital, Sydney, NSW 2750, Australia.
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MeSH Terms
Asphyxia Neonatorum / blood,  diagnosis*
Biological Markers / blood
Blood Gas Analysis
Cohort Studies
Fetal Hypoxia / complications,  diagnosis*
Gestational Age
Hydrogen-Ion Concentration
Hypoxia-Ischemia, Brain / blood,  diagnosis*,  etiology
Infant, Newborn
Intensive Care Units, Neonatal
Lactates / blood*
Predictive Value of Tests
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Reg. No./Substance:
0/Biological Markers; 0/Lactates

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