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Dear 99Nicu friends:

In this thread I want to know your opinion about:

1.- Which is the real validity of result of lactate in blood gases.

2.- Does the lactate in the neonatal period is really a predictor of good or bad prognosis(neurologic)

3.- Can you tell which decision you make whne you have a blood gas lactate value high.

4.- Which is the value of blood gas lactate that really worry.

This questions are because in my unit there is a tendency of give a saline bolus at 10-15 ml/Kg in all the babies that have little, moderate or high lactate value. I understand that if there a severe organic disfunction is logically that the lactate value it will be high, but there ar others causes of high lactate that no require saline bolus.

thanks in advance, and if you haVE SOME articles I will appreciate.

Your friend. Manuel

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Dear Manuel,

I do not have real knowledge about this and would appreciate responses from other members too. We also get s-lactate levels on our new blood gas machine but we do not consider the values so much.

Naturally, in investigations for metabolic diseases, we generally check lactate in blood and liqour.

But I guess your question is more related to whether lactate reflects poor peripheral perfusion (indicated by your protocol for giving saline bolus if lactate increase).

Will do some PubMed search later since this question also interests me, just need some recovery from my night shift!

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  • 2 months later...
Guest mbayari

Hi dear

Ourexperience is that the interpretation of lactate level alone can not be so helpful; you should into account PH value, PcO2...The AAP/ ACOG committees on maternal-fetan medicine in 1993 have clearly defined the birth asphyxia criteria. Searches are still ongoing to find a "marker" of bad outcome and blood lactate seems not to be one them; some authors have proposed the evaluation of urinary lactate/ creatinine ratio as a marker of outcome. Recent advances in this field are focusing on neuroimaging prognostic markers (Apparent Diffusion Coefficient, Diffusion Tensor Imaging and MRS: lactate/coline in basalganglia and white matter;NAA/ choline...). SNAP-PE is well correlated to 30 months outcome in a population of term birth asphyxia.

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  • 8 months later...

Hi

we use commonly lactate with other parametres and not alone to identify signs and risks for:

* septic risk (early or late onset sepsis)

* circulatory insuffisancy

* ischemic-hypoxemic encephalopathia of the term newborn

* response to ressucitation

the cinetic of values is very important but i can't say to you which valus is the define marker.

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  • 5 years later...
Guest mmerocru

Hi

We have a disscussion last week about lactate in ascitis liquid. Is depend on level of lactate in blood? Or is a good indicator of bacterian perithonitis? I think if > 4 mmol/L is a good indicator of bacterial perithonitis.

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Guest khader

Hi

 

Agree that blood lactate cannot be used solely in initially deciding if baby needs fluid resuscitation but if the clinical scenario is one of perinatal hypoxia or severe sepsis then a persistently elevated lactate would indicate a poor prognosis. Some articles worth going through.

https://www.webmedcentral.com/wmcpdf/Article_WMC00694.pdf

http://www.med.or.jp/english/pdf/2005_06/268_276.pdf

http://fn.bmj.com/content/76/1/F15.full

http://fn.bmj.com/content/96/4/F275.full.pdf?sid=c82e9db6-8ecf-4b83-aca5-8e61633e78e9

 

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  • 3 weeks later...
Guest drharry
Dear 99 Nicu friends, 
 
When you say  Lactate please be  specific ,,..eg.  cord/ umbilical  or is  Capillry  or arterial or venous blood lacate ..
 
I will try to answer above  questions
 
1.- Which is the real validity of result of lactate in blood gases.
 
Validity of Umbilical lacate or Post natal blood lacate value depends on clinical condition and associated metaboilic acidosis. Our policy (most units in UK) is to monitor babies with high lactates. Normal lactate values in umbilical blood are not establsihed, see references below for guidance. For post natal neonates (after few hours of birth) we usually take Adult value i.e < 2 mmol/L as normal. We always confirm by  repeat lacate in arterial sample  (as it could be falsely high from cold foot in capillary/venous sample) 
 
2.- Does the lactate in the neonatal period is really a predictor of good or bad prognosis(neurologic)
 
There is no credible evidence for or against it. If lacate is high one needs to be cautious, as we need to look at the whole clinical picture. High lactate has usual association with metabolic acidosis, HIE or IEMs. 
 
3.- Can you tell which decision you make when  you have a blood gas lactate value high.
 
if lacate is significantly high and corrrealtes with clinical condition act accordingly.
If baby looks well but lactate is  high..first repeat lacate in arterial sample (as it could be falsely high from cold extremity in capillary sample) 
Our policy (most units in UK) is to monitor babies with high lacates. We rule out sepsis(partial or full septic screen based on risk factors)  and also do LFT or RFT to watch for hypoxic injury to liver or kidney as well as clinically montoring babies. Usually high lactate values normalise in few hours after birth. 
 
4.- Which is the value of blood gas lactate that really worry.
 
Mean umbilical artery blood lactate level may range from   0.4 to 5.1 mmol/L, slight variation is found  with type of delivery  (spontaneous vaginal deliveries , instrumental deliveries,  and emergency cesarean deliveries) .I  personally watch for anything in umbilical cord arterial values >6 mmmol/L.. but that is my personal opinion. The threshold lactate value predictive of adverse short-term neonatal outcome depends on the lactate meter used and is difficult to ascertain . In studies in babies with moderate to severe HIE and scalp blood lactate levels, ranged from 6.1 to 8.8 mmol/L ,in  and umbilical artery l, the lactate levels ranged from 5.73 to 7.12 mmol/L (umbilical artery lactate of 5.70 mmol/L had sensitivity and specificity of 69 and 88 percent in one study). One can decide when to worry based on above evidence or if something new comes up.
 
 
References 
 
Hamed HO. Intrapartum fetal asphyxia: study of umbilical cord blood lactate in relation to fetal heart rate patterns. Arch Gynecol Obstet 2013; 287:1067.
Westgren M, Divon M, Horal M, et al. Routine measurements of umbilical artery lactate levels in the prediction of perinatal outcome. Am J Obstet Gynecol 1995; 173:1416.
Nordström L, Malcus P, Chua S, et al. Lactate and acid-base balance at delivery in relation to cardiotocography and T/QRS ratios in the second stage of labour. Eur J Obstet Gynecol Reprod Biol 1998; 76:157.
Kruger K, Hallberg B, Blennow M, et al. Predictive value of fetal scalp blood lactate concentration and pH as markers of neurologic disability. Am J Obstet Gynecol 1999; 181:1072.
Haiju Z, Suyuan H, Xiufang F, et al. The combined detection of umbilical cord nucleated red blood cells and lactate: early prediction of neonatal hypoxic ischemic encephalopathy. J Perinat Med 2008; 36:240.
 
 
Regards
 
Dr H Sharma
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  • 3 months later...

An off shoot from this topic is the question of whether lactate informs the commencement of enteral feeds. Do any other units follow this practice. We don't commence feeds until the lactate falls below 4.

Regards

Ali

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