Capillary Lactate Measurement Research Articles

Role of Lactate Measurement in Flap Monitoring: An Useful Adjunct.

Background Detection of vascular compromise in flap is often a challenging task for reconstructive surgeons. A timely salvage procedure depends on objectivity and reliability of postoperative flap monitoring. This study determined if flap capillary lactate helps in prediction of flap viability in first 48 postoperative hours of surgery. Methods We conducted this study on all flaps with accessible skin paddle where capillary lactate values were assessed along with clinical observation to check viability of flap at 0, 1, 6, 12, 24 and 48 hours of surgery. The data was statistically analyzed for significance and area under the receiver operating characteristic curve was used for calculating cutoff value for lactate. Results Out of a total of 30 patients included in this study, 25 were males and the mean age was 45.03 years. Fifteen patients underwent free flap and rest pedicled. Highly significant association of role of clinical observation in the outcome of flap was found. The average of lactate values for survived and distally ischemic flap was 5.32 ± 1.91 and 8.38 ± 1.81, respectively, which was highly significant. The cutoff value of lactate below which all flaps survived was found to be 6.09 mmol/L. Conclusion Flap capillary lactate measurement is an easy, quick, cost-effective, and objective tool for checking viability of flaps.

Validation of a point-of-care capillary lactate measuring device (Lactate Pro 2)

BackgroundThe measurement of lactate in emergency medical services has the potential for earlier detection of shock and can be performed with a point-of-care handheld device. Validation of a point-of-care handheld device is required for prehospital implementation.AimThe primary aim was to validate the accuracy of Lactate Pro 2 in healthy volunteers and in haemodynamically compromised intensive care patients. The secondary aim was to evaluate which sample site, fingertip or earlobe, is most accurate compared to arterial lactate.MethodsArterial, venous and capillary blood samples from fingertips and earlobes were collected from intensive care patients and healthy volunteers. Arterial and venous blood lactate samples were analysed on a stationary hospital blood gas analyser (ABL800 Flex) as the reference device and compared to the Lactate Pro 2. We used the Bland-Altman method to calculate the limits of agreement and used mixed effect models to compare instruments and sample sites. A total of 49 intensive care patients with elevated lactate and 11 healthy volunteers with elevated lactate were included.ResultsThere was no significant difference in measured lactate between Lactate Pro 2 and the reference method using arterial blood in either the healthy volunteers or the intensive care patients. Capillary lactate measurement in the fingertip and earlobe of intensive care patients was 47% (95% CI (29 to 68%), p < 0.001) and 27% (95% CI (11 to 45%), p < 0.001) higher, respectively, than the corresponding arterial blood lactate. In the healthy volunteers, we found that capillary blood lactate in the fingertip was 14% higher than arterial blood lactate (95% CI (4 to 24%), p = 0.003) and no significant difference between capillary blood lactate in the earlobe and arterial blood lactate.ConclusionOur results showed that the handheld Lactate Pro 2 had good agreement with the reference method using arterial blood in both intensive care patients and healthy volunteers. However, we found that the agreement was poorer using venous blood in both groups. Furthermore, the earlobe may be a better sample site than the fingertip in intensive care patients.

Agreement between capillary and venous lactate in emergency department patients: prospective observational study

ObjectivesCapillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement...

Hemodynamically efficient portal decompression: the concept of competing spontaneous and surgical shunts

Introduction: Temporary portocaval shunt (PCS) has a positive impact on short-term outcomes after liver transplantation (LT). An alternative to this proximal shunt is a distal passive decompression through mesenterico-saphenous shunt (MSS). The goal of this study was to compare the efficiency of spontaneous and surgical distal versus proximal shunts and discuss their respective place during the anhepatic phase in regard to the anatomy of preexisting spontaneous shunts. Method: Patients transplanted in a 2-year period who underwent portal decompression during the anhepatic phase were included. Intraoperative and in-hospital course were compared according to 2 types of surgical decompression techniques: PCS (n = 44) and MSS (n = 77). The impact of spontaneous shunt anatomy on the hemodynamic and metabolic efficiency of surgical shunts using portal pressure and capillary lactate measurements as well as on early graft function were evaluated. Results: MSS and PCS showed a comparable hemodynamic and metabolic efficiency with no significant difference in terms of portal pressure variations and gut lactate production. There was no significant difference in terms of reperfusion syndrome, transfusion rate, renal failure nor early allograft dysfunction (p = 0.956, 0.575, 0.239 and 0.976 respectively). In case of competing shunts (example: PCS and splenorenal shunt or MSS and left gastric shunt), there was a significantly higher rate of EAD (67% vs 13%; p = 0.002). Conclusion: Classical portacaval anastomosis and passive mesenterico-saphenous shunt offer similar hemodynamic and metabolic efficiency without impacting on the outcomes after liver transplantation. Their respective place should be discussed in regard to the anatomy of preexisting portosystemic shunts.

Capillary and venous lactate measurements with a handheld device compared to venous blood-gas analysis for emergency patients

Background/aimEarly identification of lactate levels may have a large impact on triage classification and assist in identifying critically ill patients. A handheld device provides a rapid and timesaving measurement of lactate levels adapted to work in a prehospital care setting. I.e., the device is small, fast, and easy-to-use. The aim of this study was to evaluate the Accutrend Plus handheld lactate analyzer in comparison to the reference in-hospital method.MethodsPatients triaged as minimum yellow according to the RETTS System (Rapid Emergency Triage and Treatment System) and transported to hospital by ambulance were selected and a written consent to participate was obtained prior to inclusion in the study. Capillary (CAP) and venous (VEN) blood were analyzed with Accutrend Plus (AP). Venous blood samples were analyzed at the local hospital laboratory (GEM premier 4000) within 20 min from sampling. All sampling was conducted by two registered nurses specially trained in prehospital care.Results480 lactate measurements were performed in 160 patients. The mean difference between measurements in capillary blood compared with the reference method was 0.7 mmol/L and for venous blood 0.9 mmol/L. The limits of agreement from the Bland-Altman plot was − 0.9 to + 2.5 mmol/L and and − 0.1 to + 1.9 mmol/L, for CAP and VEN compared with GEM.ConclusionOur results shows low accuracy and low precision with VEN / CAP measurements of lactate compared to reference GEM.

Capillary and venous point-of-care testing of lactate concentrations in the emergency department: a prospective observational study

BackgroundHyperlactatemia is a sensitive marker for early identification of patients who are critically ill. Rapid capillary lactate measurement using a handheld device can hasten the identification of patients at risk. We aimed to compare capillary lactate with venous blood lactate assessed using a blood gas analyser in the emergency department. MethodsThis was a prospective observational study of patients presenting to the emergency department in Hong Kong SAR. Venous and fingertip capillary blood samples were collected for lactate analysis. Venous lactate concentrations measured using a point-of-care blood gas analyser was used as a reference method (VL-Ref). Capillary lactate concentrations were measured using two handheld analysers: (1) Nova StatStrip Xpress (CL-Nova); and (2) Lactate Scout+ (CL-Scout+). Venous lactate measurements were also done using two handheld analysers (VL-Nova and VL-Scout+). Bland-Altman analysis was used to determine the agreement between different methods of measurement. Ethics approval was obtained from the Institutional Review Board of the Chinese University of Hong Kong (CREC 2015.624). Written consent was obtained either from the patient or a relative in all cases. The study is registered with ClinicalTrials.gov (NCT02694887). FindingsBetween March and July, 2016, we recruited 240 patients (aged 18 years or older) who were triage category 3 (urgent) presenting to the emergency department. Of 240 patients (mean age 69·9 years; 54% men), lactate concentrations were in the range 0·70–5·38 mmol/L (mean 1·96mmol/L). 151 patients (63%) had lactate concentrations (VL-Ref) less than 2 mmol/L, and 89 patients (37%) had lactate concentrations of at least 2 mmol/L. The results of a Bland-Altman analysis showed that percentage of mean difference were −6·2% between VL-Ref and CL-Scout+, 29·9% between VL-Ref and CL-Nova, with 95% limits of agreement of −79·3 to 66·8% and −43·8 to 103·6%, respectively. Regarding venous blood lactate, the results showed bias values of 13% between VL-Ref and VL-Scout+, 55·3% between VL-Ref and VL-Nova, with limits of agreement being −23·9 to 49·9% and 20·7 to 90·0%, respectively. InterpretationAn overall low systemic bias were observed in CL-Scout+ (bias −6·2%) and VL-Scout+ (bias 13%), suggesting the potential clinical utility of the Scout+ handheld analyser. However, the wide range of limits of agreement implies poor precision of using fingertip capillary blood for lactate testing. Further studies are needed to validate the use of capillary lactate in emergency settings. FundingDirect Grant for Research, The Chinese University of Hong Kong.

Physiological responses and external validity of a new setting for taekwondo combat simulation.

Combat simulations have served as an alternative framework to study the cardiorespiratory demands of the activity in combat sports, but this setting imposes rule-restrictions that may compromise the competitiveness of the bouts. The aim of this study was to assess the cardiorespiratory responses to a full-contact taekwondo combat simulation using a safe and externally valid competitive setting. Twelve male national level taekwondo athletes visited the laboratory on two separate occasions. On the first visit, anthropometric and running cardiopulmonary exercise assessments were performed. In the following two to seven days, participants performed a full-contact combat simulation, using a specifically designed gas analyser protector. Oxygen uptake (), heart rate (HR) and capillary blood lactate measurements ([La-]) were obtained. Time-motion analysis was performed to compare activity profile. The simulation yielded broadly comparable activity profiles to those performed in competition, a mean of 36.6 ± 3.9 ml.kg-1.min-1 (73 ± 6% ) and mean HR of 177 ± 10 beats.min-1 (93 ± 5% HRPEAK). A peak of 44.8 ± 5.0 ml.kg-1.min-1 (89 ± 5% ), a peak heart rate of 190 ± 13 beats.min-1 (98 ± 3% HRmax) and peak [La-] of 12.3 ± 2.9 mmol.L–1 was elicited by the bouts. Regarding time-motion analysis, combat simulation presented a similar exchange time, a shorter preparation time and a longer exchange-preparation ratio. Taekwondo combats capturing the full-contact competitive elements of a bout elicit moderate to high cardiorespiratory demands on the competitors. These data are valuable to assist preparatory strategies within the sport.

Comparison of capillary and arterial lactate levels in patients with shock

ObjectiveSeveral guidelines recommend point-of-care lactate measurements for therapeutic decision-making in patients with shock. The aim of the study was to validate capillary lactate measurements with a bedside micromethod in patients with shock. Study designProspective observational study. Patients and measurementsCapillary lactate levels measured by a micromethod (CAPI) and arterial lactate levels measured by a standard laboratory method (ARTs) were simultaneously and repeatedly assayed in consecutive ICU patients with shock. The validity and clinical acceptability of the CAPI method was assessed from its reproducibility, the arterio-capillary lactate difference (ACLD) and conventional diagnostic indicators. Main resultsLactate measurements were available for 139 time-points in 37 patients. CAPI values correlated well with ARTs values (intraclass coefficient correlation: r2=0.92, P<0.001). CAPI had a sensitivity of 98%, a specificity of 36%, an accuracy of 88% and a positive predictive value of 89% to detect lactate values≥2mmol/L (P<0.0001). The mean bias between the two methods (ACLD: 0.56±2.21mmol/L) was mainly due to higher lactate concentration in capillary blood. ConclusionCAPI was correctly correlated to ARTs. The bias between the two methods is probably acceptable for triage purpose. Patients with elevated capillary lactate or in shock should be monitored with atrial-based lactate.

National Early Warning Score Lactate (NEWS–L): is it good news for pre-hospital care?

Journal of Paramedic PracticeVol. 8, No. 10 Spotlight on ResearchNational Early Warning Score Lactate (NEWS–L): is it good news for pre-hospital care?Jack BarrettJack BarrettSearch for more papers by this authorJack BarrettPublished Online:22 Oct 2016https://doi.org/10.12968/jpar.2016.8.10.515AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Dassonville J, et al. (1998) Blood lactate concentrations during exercise: effect of sampling site and exercise mode. Journal of Sports Medicine and Physical Fitness 38(1): 39–46 Google ScholarFeliu J, et al. (1999) Difference between lactate concentration of samples from ear lobe and the finger tip. Journal of Physiology and Biochemistry 55(4): 333–339 Google ScholarForsyth JJ, Farrally MR (2000) A comparison of lactate concentration in plasma collected from the toe, ear, and fingertip after a simulated rowing exercise. British Journal of Sports Medicine 34: 35–38 Crossref, Google ScholarLightowler B, Hoswell A (2016) Can handheld POC capillary lactate measurement be used with arterial and venous laboratory testing methods in the identification of sepsis? Journal of Paramedic Practice 8(8): 396–406 Link, Google ScholarVincent J, et al. (2016) The value of blood lactate kinetics in critically ill patients: a systematic review. Critical Care 20: 257 Crossref, Google Scholar References Jo S, Yoon J, Baek Lee J, Jin Y, Jeong T, Park B (2016) Predictive value of the National Early Warning Score–Lactate for mortality and the need for critical care among general emergency department patients. Journal of Critical Care 36: 60–68. doi https://doi.org/10.1016/j.jcrc.2016.06.016 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 October 2016Volume 8Issue 10ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 22 October 2016 Published in print 2 October 2016 Information© MA Healthcare LimitedPDF download

Capillary and Venous Lactate Agreement: a pilot prospective observational study

BackgroundBlood lactate is a marker of patient illness severity. Capillary lactate (CAP-LACT) measurement can potentially improve patient screening; however, it has poor evidence of clinical utility.AimWe aimed to investigate agreement...

Can handheld POC capillary lactate measurement be used with arterial and venous laboratory testing methods in the identification of sepsis?

Background: The aim of this review was to examine whether the measurement of lactate in capillary blood samples using point-of-care handheld analysers corresponds sufficiently closely with arterial and venous whole-blood samples analysed by hospital central laboratory or blood gas analyser to be used interchangeably. Methods: A systematic search, informed by focused inclusion/exclusion criteria, was performed using multiple databases up to October 2015. A total of 65 articles were considered to have potential relevance and were evaluated in full text, of which ultimately five articles met all inclusion/exclusion criteria, and a final four were selected after data extraction and quality appraisal. Results and Conclusion: All four studies found a predominantly upward bias in the measurement of lactate in capillary samples tested using a handheld point-of-care device over arterial or venous samples tested by laboratory methods or blood gas analyser. In terms of correlation, there was consensus between the studies that the strength of association between the two methods of measurement was statistically significant. Three studies directly examined the extent of agreement between point-of-care capillary lactate measurements and those of laboratory or blood gas analyser reference determined to ±2 standard deviations; 95% confidence intervals, and report contextually broad limits of agreement, identifying a potential for both over triage and, to a lesser extent, under triage. The findings of the review do not support interchangeable use of handheld fingertip point-of-care lactate measurement with laboratory or blood gas analyser methods in the identification of sepsis.

Capillary lactate concentration on admission of normotensive trauma patients: a prospective study.

BackgroundElevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients. Point-of-care (POC) capillary lactate measurement devices may be useful to rapidly assess lactate concentration at the bedside. The aim of this study was to test the diagnostic performance of capillary lactate to predict significant transfusion in normotensive trauma patients.MethodsWe conducted a prospective observational study in one level-I trauma centre. From August 2011 to February 2013, 120 consecutive adult patients with systolic blood pressure (SBP) higher than 90 mmHg were included. Capillary lactate was measured on admission in the trauma bay. The primary outcome was defined as a significant transfusion within the first 48 h. Diagnostic performance was determined using receiver operating characteristic (ROC) curve analysis. We also tested the agreement between capillary lactate and blood lactate concentrations using Bland and Altman analysis.ResultsOf the 120 normotensive trauma patients, 30 (25 %) required at least one unit of packed red blood cells (RBC) and 12 (10 %) patients received at least four RBC within the first 48 h. All patients with significant RBC transfusion had capillary lactate higher than 3.5 mmol/l. The area under the ROC curve of capillary lactate on admission to predict transfusion of at least 4 RBC units was 0.68 [95 % CI 0.58 – 0.78]. The average bias between capillary and blood lactate measurements was 2.4 mmol/l with a standard deviation of 3.0 mmol/l (n = 60 patients).ConclusionsAlthough a significant association was found between POC lactate concentration and transfusion requirements, the diagnostic performance of capillary lactate measurements was poor. Due to large disagreement between capillary lactate and blood lactate, capillary lactate cannot be considered in the clinical setting.Trial registrationClinicalTrials.gov, No. NCT01793428.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0272-x) contains supplementary material, which is available to authorized users.

Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report

BackgroundThe triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED.MethodsThis was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded.ResultsOne hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and 28-day mortality was 16%. Capillary lactate at ED presentation was significantly higher among 28-day non-survivors than among survivors (5.7 mmol.L−1 [3.2 to 7.4] vs 2.9 mmol.L−1 [1.9 to 5.2], p = 0.003). A score based on mottling and capillary lactate concentration >3.6 mmol.L−1 was significantly associated with 28-day mortality (area under curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC global model 0.87).ConclusionsA high capillary lactate concentration measured by the triage nurse among patients presenting to the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.

Capillary measurement of lactate and glucose for free flap monitoring

It is reported that the salvage rate of free flaps is inversely related to the time interval between the onset of pedicle impairments and their clinical recognition. Monitoring of free flaps is therefore of major importance and clinical monitoring remains the most used technique because of lack of low-cost and non-invasive techniques. The authors suggested an efficient, simple and cheap technique to detect early thrombotic events in monitoring free flaps with skin paddle. In this multicentre prospective study, measurements of capillary glucose and lactate in the flaps were done. These parameters were compared to standardized clinical monitoring during the first five days. Two sets of data (eventful versus uneventful postoperative period) were analyzed to define the thresholds of lactate and glucose values for diagnosis of pedicle complications, and to establish parameters for this screening test. Over a period of 19 months, 37 patients were included. With 5 pedicle impairments, complication thresholds were defined as lactate ≥ 6.4 mmol L(-1) and glucose ≤ 3.85 mmol L(-1), in order to obtain a sensitivity of 98.5% and a specificity of 99.5% for the test. Modifications of capillary glucose and lactate measurements appeared in average 5.7 hours earlier than clinical symptoms in pedicle impairments. The mean cost of a five-day monitoring was about 90 USD. This simple and cheap technique could be used as a routine technique in monitoring free flaps to improve safety of this reconstructive technique.

Point-of-care Capillary Blood Lactate Measurements in Human Immunodeficiency Virus–uninfected Children With In Utero Exposure to Human Immunodeficiency Virus and Antiretroviral Medications

To estimate the prevalence of elevated point-of-care (POC) capillary blood lactate concentrations in human immunodeficiency virus (HIV)-exposed, uninfected children (HEU) and to determine if POC lactate varies with in utero antiretroviral (ARV) exposure. The Surveillance Monitoring for Antiretroviral Therapy Toxicities protocol of the Pediatric HIV/AIDS Cohort Study enrolled 1934 children between 2007 and 2009, 0 to 12 years of age, born to HIV-infected mothers. POC lactate was measured annually on capillary blood using the Lactate Pro device. Associations of POC lactate with in utero ARV exposure and other characteristics were evaluated using logistic regression models, adjusting for maternal characteristics and other confounders. Of 1641 children with POC measurements (median age, 3.0 years), 3.4% had POC lactate >3 mmol/L. Median POC lactate level decreased with age (1.9 mmol/L, 1.7 mmol/L, and 1.6 mmol/L for children 0-<6 months [99% ≤6 weeks of life], 6-<24 months, and ≥24 months of age, respectively; P < 0.001). Prevalence of elevated POC lactate did not differ by in utero ARV exposure drug class, but was significantly higher in children exposed in utero to emtricitabine or efavirenz, cocaine or opiates, and those of white race. POC lactate testing is a useful rapid laboratory screening assay for HEU children with ARV exposure. ARV use during pregnancy has resulted in a dramatic decrease in mother-to-child transmission of HIV, and the risk of elevated lactate in HEU children is low. However, as new ARVs and more complex regimens are used during pregnancy by HIV-infected women, continued monitoring for infant toxicities is essential.

Correlation Between Arterial and Capillary Lactate Measurements in a Porcine Hemorrhagic Shock Model

Collange, Olivier MD; Charton, Antoine MD; Greib, Nicolas MD; Joshi, Girish P. MBBS, MD, FFARCSI; Schaeffer, Roland MD; Diemunsch, Pierre A. MD, PhD Author Information

Lactate measurement by the capillary method in shocked patients

Arterial blood lactate is a reliable indicator of tissue oxygen debt and is of value in expressing the degree and prognosis of circulatory failure. Compared with arterial measurement, capillary lactate measurement is easier, faster, cheaper and lowers the incidence of arterial puncture complications. Capillary lactate measurement has been already validated to assess fetal well-being. The aim of this study was to compare arterial and capillary lactate in adult shocked patients.

Comprehensive isokinetic knee measurements and quadriceps tendon evaluations in footballers for assessing functional performance

Objectives: To ascertain whether detailed isokinetic knee muscle testing reflects the results of other functional measurements in footballers and to look for any correlations between quadriceps tendon thickness and knee...

Agreement between capillary and arterial lactate in the newborn

Arterial blood lactate is a reliable indicator of tissue oxygen debt and is of value in expressing the degree and prognosis of circulatory failure as a result of various diseases. Therefore, the practical issue of whether capillary lactate measurements might be of equal value was investigated in newborns. In total, 193 simultaneous measurements of capillary and arterial blood lactate concentrations were performed in 25 newborn babies with an indwelling umbilical arterial catheter. A strong linear correlation was found between capillary and arterial lactate concentration (Lcap= 1.02 Lart+ 0.04; r= 0.98; p &lt; 0.001). The mean difference was −0.08 mmol/1 and the limits of agreement (± 2 SD) were ± 0.69 mmol/1 (−0.77 to 0.61 mmol/1). Conclusion: Our data show that capillary blood lactate measurements in newborn babies yield lactate concentrations equivalent to arterial measurements over a large concentration range.

The value of capillary whole blood lactate for blood transfusion requirements in anaemia of prematurity.

To evaluate the usefulness of blood lactate as an indication for blood transfusion in anaemia of prematurity by means of a study protocol which considers the site of blood sampling and the repeatability of lactate measurements. Prospective clinical study. Multidisciplinary, neonatalpaediatric intensive care unit of a non-university, teaching children's hospital. Comparison of pre- and 48-h post-transfusion capillary whole blood lactate in 18 anaemic premature babies. In 30 neonates the agreement between capillary and arterial lactate was analysed by using the Bland Altman plot. In 30 stable premature infants four capillary lactate measurements were carried out within 24 h and analysed with regard to variability (coefficient of variation (CV); association between SD and mean) and to establish normal values. In the transfused infants, haematocrit increased from 23 (SD 3)% to 37 (SD 3)%. Mean lactate decreased from 2.5 (SD 1.0) to 1.7 (SD 0.5) mmol/l (p = 0.003). Pretransfusion lactate did not correlate with pre-transfusion haematocrit, heart rate, respiratory rate, number of apnoeas/bradycardias and weight gain (multiple regression). The mean difference between capillary and arterial lactate was 0.17 (SD 0.24) mmol/l and the 95 % confidence interval (CI) was -0.31 to 0.65 mmol/l. The CV of repetitive measurements was 19.8 (SD 9.8)% and SD correlated positively with mean lactate values (p = 0.001); the 95 % CI (normal range for premature infants) was 1.56-1.90 mmol/l. Capillary whole blood lactate measurements in newborn babies agree excellently with arterial values. Lactate measurements add little information to the decision whether to transfuse or not, considering the variability of this parameter in stable premature infants and the lack of correlation with other possible clinical indicators of compromised oxygen delivery.