Perinatal palliative care or termination of pregnancy after prenatal diagnosis of lethal fetal abnormality

Abstract

Moderate to severe encephalopathy developed in 28 (33%) and 10 (11.9%) infants, respectively; all with severe encephalopathy died. First postnatal blood lactate concentrations, measured at a median (IQR) age of 65 min (38–119 min), ranged from 0.5 to 42.7 mmol/l. All infants with first lactate of <12 mmol/l survived but 24% of those with values above this died. Median (IQR) first postnatal blood lactate concentration was significantly higher among infants with moderate to severe encephalopathy than among those with no or mild encephalopathy [19 (14.6–22) vs. 8.4 (5.22–12.5); p<0.0001]. Blood lactate concentration showed similar discriminating ability for prediction of moderate to severe encephalopathy as the first postnatal pH or base excess [area under ROC curve – 0.88 (S.E.=0.04), 0.78 (S.E.=0.06) and 0.82 (S.E.=0.06), respectively}. The sensitivity, specificity, positive and negative predictive values of first postnatal blood lactate concentration of ≥12 mmol/l for moderate to severe encephalopathy were 92%, 67%, 58% and 95%, respectively, the corresponding values for a composite predictor (5-min Apgar score≤5, or pH<7.0, or base excess≤−16 mmol/l) being 93%, 39%, 43% and 92%, respectively. Lactate concentration of ≥12 mmol/l correctly classified 75% of infants compared to 57% when the composite predictor was present. Conclusions: Elevated blood lactate concentration during the first 3 h after birth is a significant predictor of moderate to severe encephalopathy, similar to that reported by Shah et al. [1]. The relationship between early hyperlactatemia and long-term neurodevelopmental outcome remains to be determined. Reference [1] Shah S, et al. J Perinatol 2004;24:16–20.