Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study.

Yi-Fang Tu,Hsin-I Shih,Chung-I Li,Lin Kang,Yung-Chieh Lin,Po-Ming Wu,Chao-Ching Huang,Cheng-Lin Wu,Wen-Hao Yu

doi:10.3390/life11111193

Abstract

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is the most common cause of mortality and neurological disability in infancy after perinatal asphyxia. Reliable biomarkers to predict neurological outcomes of neonates after perinatal asphyxia are still not accessible in clinical practice. Methods: A prospective cohort study enrolled neonates with perinatal asphyxia. Biochemical blood tests and cerebral Doppler ultrasound were measured within 6 h of age and at the 4th day old. Neurological outcomes were assessed at 1 year old. Results: Sixty-four neonates with perinatal asphyxia were enrolled. Fifty-eight (90%) had hypoxic-ischemic encephalopathy (HIE) including 20 (34%) Stage I, 21 (36%) Stage II, and 17 (29%) Stage III. In the asphyxiated infants without therapeutic hypothermia, HIE stage, PH, and base excess levels within 6 h of age were the predictors of adverse outcomes. In the asphyxiated infants receiving therapeutic hypothermia, HIE stage failed to predict outcomes. Instead, blood lactate levels and pulsatility index (PI) of medial cerebral arteries (MCA) either in 6 h of age or at the 4th day old independently predicted adverse outcomes. Conclusions: Blood lactate, which is a common accessible test at the hospital and MCA PI on cerebral ultrasound could predict adverse outcomes in asphyxiated infants receiving therapeutic hypothermia.

Highlights

Neonatal hypoxic-ischemic encephalopathy (HIE) is the most common cause of mortality and neurological disability in infancy after perinatal asphyxia
It is an important cause of acquired neonatal brain injury in term neonates leading to neonatal hypoxic-ischemic encephalopathy (HIE), which is the most common cause of death and neurological disability in human neonates [3,4,5]
We demonstrate the ability of some bed-side available, relatively objective examinations in asphyxiated infants during the acute postnatal period to severe as the early predictors of adverse neurodevelopmental outcomes at 1 year old

Summary

Introduction

Neonatal hypoxic-ischemic encephalopathy (HIE) is the most common cause of mortality and neurological disability in infancy after perinatal asphyxia. Perinatal asphyxia occurs in 1–1.5% of live births in developed countries, and higher in developing countries [1,2]. It is an important cause of acquired neonatal brain injury in term neonates leading to neonatal hypoxic-ischemic encephalopathy (HIE), which is the most common cause of death and neurological disability in human neonates [3,4,5]. In infants with HIE, the overall mortality was 15–25%, and up to 1/3 survivors tend to develop longterm neurological disabilities such as mental retardation, cerebral palsy, and epilepsy [5,6]. Prognostication remains challenging but essential for parental counseling and intensive care management, including the use of further neuroprotective strategies [14]

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