Umbilical Arterial Lactate Research Articles

Utility of Umbilical Arterial Blood Gas Lactate Levels in Predicting Short-term Neonatal Morbidity: A Retrospective Audit in a Tertiary Neonatal Unit

Utility of Umbilical Arterial Blood Gas Lactate Levels in Predicting Short-term Neonatal Morbidity: A Retrospective Audit in a Tertiary Neonatal Unit

Umbilical arterial blood lactate as predictor of early neonatal outcome and evaluation of intrapartum asphyxia

BackgroundPerinatal asphyxia is a leading cause of under-5 mortality and exerts great pressure on the health system. Adequate foetal monitoring in labour is paramount in the early detection of foetal distress to prevent perinatal asphyxia. Several methods of foetal monitoring are in use with varying efficacy. This study investigated the efficacy of umbilical arterial (UA) lactate assay in predicting adverse perinatal outcomes. MethodologyThis was a prospective longitudinal study involving 160 pregnant women in the active phase of labour at term who met the inclusion criteria. They were recruited using a consecutive sampling technique and underwent a cardiotocography. Then they were classified into normal and abnormal cardiotocographic groups. At delivery, the UA blood of all of the babies was collected and assayed for serum lactate, and the levels were correlated with the perinatal outcome. The perinatal outcomes were measured by Apgar scores, admission into the neonatal unit, and hypoxic ischaemic encephalopathy. Analysis was done to determine the sensitivity and specificity of UA lactate in predicting birth asphyxia, hypoxic ischaemic encephalopathy, and neonatal unit admission. ResultsThe mean age ± standard deviation (SD) between the two cardiotocography (CTG) groups, normal years (30.55 ± 5.59) and abnormal years (29.86 ± 5.51), were similar. A critical UA lactate concentration > 9.1 mmol/L predicted Apgar scores < 7 at 5 min with a sensitivity and specificity of 76.47% (CI: 50.1–93.2) and 91.55% (CI: 85.7–95.6%), respectively. Also, the need for neonatal unit admission was predicted at a cut-off point >9.1 mmol/L with a sensitivity of 61.90% (CI: 38.4–81.9) and specificity of 91.30% (CI: 85.3–95.4). Umbilical artery lactate levels > 11.2 mmol/L predicted the development of hypoxic ischaemic encephalopathy in neonates with a sensitivity of 100% (CI: 39.8–100.0) and specificity of 88.39% (CI: 82.3–93.0). ConclusionUmbilical artery lactate correlates with adverse pregnancy outcomes and is an excellent tool for predicting adverse neonatal outcome.

Effect of maternal oxygen supplementation for parturient undergoing elective cesarean section by high-flow nasal oxygen compared with room air on fetal acidemia: study protocol for a randomized controlled trial

BackgroundMaternal oxygen supplementation is usually used as an intrauterine resuscitation technique to prevent fetal hypoxia and acidemia during delivery. However, there has been a great deal of controversy regarding the effects of prophylactic maternal oxygen during cesarean section, during which the incidence of fetal acidemia seems to be higher compared with that during labor. High-flow nasal oxygen (HFNO) can improve oxygenation better in patients with high-flow oxygen airflow. The purpose of this study is to determine whether maternal oxygen supplementation with HFNO has a positive effect on fetal acidemia during cesarean section through umbilical arterial blood gas analysis.MethodThis prospective, single-center, randomized, double-blinded trial will enroll 120 patients undergoing cesarean section. Participants will be randomly assigned to the HFNO group or air group at a 1:1 ratio. For parturients in the HFNO group, the flow rate is 40L/min, and the oxygen is heated to 37℃ with humidity 100% oxygen concentration through the Optiflow high-flow nasal oxygen system. And for the air group, the flow rate is 2 L/min with an air pattern through the same device. The primary outcome was umbilical artery (UA) lactate. Secondary outcomes include UA pH, PO2, PCO2, BE, the incidence of pH < 7.20 and pH < 7.10, Apgar scores at 1 and 5 min, and neonatal adverse outcomes.DiscussionOur study is the first trial investigating whether maternal oxygen supplementation with HFNO can reduce the umbilical artery lactate levels and the incidence of fetal acidemia in cesarean section under combined spinal-epidural anesthesia.Trial registrationClinicalTrials.gov NCT05921955. Registered on 27 June 2023.

Umbilical arterial lactate levels after normal vaginal and elective cesarean delivery: The role of a longer active second stage most significant in high levels after vaginal delivery.

To evaluate umbilical arterial lactate concentrations after spontaneous vaginal delivery and after elective Cesarean delivery, and to study the simultaneous effects of maternal and obstetric variables in high lactate levels in vaginally delivered healthy term singletons. The birth register study included information about the umbilical artery lactate values and clinical perinatal data from 7723 women and their singleton newborns (7301 spontaneous vaginal and 422 elective cesareans) from Kuopio University Hospital, Finland. High lactate levels were evaluated more extensively among healthy term neonates (N = 6541), to evaluate high levels after normal vaginal labors. The mean lactate level was significantly lower after elective cesarean compared to vaginal delivery (2.42 [0.94] vs. 3.56 [1.62] mmol/l; p < 0.0001). Consequently, the 90th percentile limit values were 3.60 and 5.80 mmol/L. Among healthy term newborns born vaginally, higher lactate values (≥5.80 mmol/L) were independently associated with a longer duration of the active second stage of labor (ORs 1.91-10.97) and duration of ruptured fetal membranes (ORs 1.36-2.46), higher gestational age at birth (ORs 1.41-1.86), null parity (OR 2.17), maternal infection (OR 1.81) and short maternal stature (OR 1.45). We report 90th/95th limits for umbilical arterial lactate values in relation to the various durations of labors for term newborns who are delivered by the vaginal route. Even though the high umbilical lactate levels may indicate serious birth asphyxia, levels after vaginal birth reflect the physiological stress and subclinical transient asphyxia frequently seen in normal vaginal deliveries.

Association of Umbilical Cord Lactate Levels and Capillary Ph with Hypoxic-Ischemic Encephalopathy in Neonates Born with Intrapartum Asphyxia

Objective: To estimate the association of umbilical cord lactate levels and pH with Hypoxic-Ischemic Encephalopathy in neonates born with intrapartum asphyxia.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of study: Pediatrics Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from February 2021 to April 2022.&#x0D; Methodology: The study was conducted on neonates born with suspicion of intrapartum asphyxia at our hospital. Umbilical cord lactate levels and capillary pH were performed within the first 30 minutes of birth. Then, neonates were admitted to the neonatal intensive care unit and followed up for three days to look for the presence and severity of Hypoxic-Ischemic Encephalopathy (HIE). Association was ascertained between raised lactate levels and negative base deficit with HypoxicIschemic Encephalopathy.&#x0D; Results: A total of 1000 neonates were included in the final analysis. From 1000 neonates with intrapartum asphyxia, 790(79%) did not develop any grade of hypoxic-ischemic encephalopathy within the first three days of birth, while 210(21%) developed either Grade-I, II or III encephalopathies. Raised serum lactate and base deficit were significantly associated with the presence and severity of hypoxic-ischemic encephalopathy in neonates born with intrapartum asphyxia (p-value&lt;0.001).&#x0D; Conclusion: Both umbilical artery lactate levels and capillary pH performed within the first 30 minutes of birth were associated with the presence and severity of Hypoxic-Ischemic Encephalopathy in neonates included in our study. These results favour lactate levels as a predictor of Hypoxic-Ischemic Encephalopathy.

Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial

BackgroundIn high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths.MethodsThis was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices.ResultsPerinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1–130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h.ConclusionMaternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.

Cord Length, Umbilical Artery Lactate Concentration and Perinatal Outcomes of Babies with Nuchal Cord at Ile-Ife, Nigeria

Background: There is inconclusive evidence on the relevance of the nuchal cord in obstetric practice. Objectives: This study aims to evaluate the umbilical artery lactate concentration and perinatal outcomes of babies born with a nuchal cord. Methods: In a cross-sectional study at the Obafemi Awolowo University Teaching Hospital, babies born with a nuchal cord at term and matched controls without a nuchal cord were recruited between January 2017 and December 2018. Gestational age at delivery, meconium-stained liquor, foetal heart rate abnormalities, Caesarean section rates, cord lengths and umbilical artery lactate concentrations were compared. The umbilical artery lactate concentration was assayed with the Lactate-Plus®; neonatal acidosis was defined as cord lactate concentration &gt; 4.9mmol/L. Results: One hundred and forty-four babies with nuchal cords and 144 controls were recruited. The prevalence of nuchal cord was 3.4%, with 80% of the babies having a single loop. Babies with nuchal cords had longer mean cord length (57.7cm vs 45.4cm; p&lt;0.01), higher mean umbilical artery lactate (4.93mmol/L vs 3.48mmol/L; p = 0.04), meconium-stained liquor (16% vs 3.2%; Relative risk = 4.6), more babies with Apgar score &lt;7 at fifth minute (9 versus 4 babies) and increased perinatal mortality (55.5/1000 births vs 13.8/1,000 births; Relative risk = 4). There was a positive correlation between cord length and the number of nuchal loops (r = 0.5, p&lt;0.01). Conclusions: Nuchal cord is associated with abnormal cord lactate concentration and adverse perinatal outcomes. Prenatal reporting may enhance intrapartum surveillance and improve perinatal outcomes.

Optimal duration of cardiotocography assessment using the iPREFACE score to predict fetal acidemia

Cardiotocography (CTG) applicability to improve fetal outcomes remains controversial. This study aimed to determine the clinically optimal CTG assessment duration using the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring (iPREFACE score). This single-center, retrospective observational study included 325 normal full-term singleton vaginal deliveries at the Toho University Omori Medical Center, from September 2018 to March 2019. The iPREFACE(10), iPREFACE(30), and iPREFACE(60) scores were calculated at 10, 30, and 60 min immediately before delivery. The primary outcome was fetal acidemia (umbilical artery blood pH < 7.2). The secondary outcome was the correlation between all iPREFACE scores and the umbilical artery blood pH, base excess (BE), and lactate values. Patients without accurate CTG findings or with failure of umbilical artery blood sampling immediately after birth were excluded, leaving 145 patients in the final analysis. Of these, 16, three, and two had umbilical artery blood pH of < 7.2, < 7.1, and < 7.0, respectively. All iPREFACE scores significantly correlated with umbilical artery blood pH, BE, and lactate values. iPREFACE(30) had the highest predictive capacity for fetal acidemia, suggesting that 30 min immediately before delivery may be a useful scoring time in clinical practice.

Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study.

Birth asphyxia is a common cause of perinatal morbidity, mortality. To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.

Association of umbilical cord blood gas values with mortality and severe neurologic injury in preterm neonates

Umbilical cord arterial and venous blood gas values reflect the acid-base balance status of a newborn at birth. Derangement in these values has been linked to poor neonatal outcomes in term and late preterm neonates; however, the utility of these values in preterm neonates of <29 weeks' gestation is unclear. This study aimed to determine the associations of umbilical cord arterial and venous blood gas values with neonatal mortality and severe neurologic injury in extremely preterm neonates and to identify the cutoff values associated with 2.5-fold increases or decreases in the posttest probabilities of outcomes. This was a retrospective cohort study of neonates who were born at 23+0 to 28+6 weeks' gestation between January 1, 2018 and December 31, 2019, and who were admitted to neonatal units in Canada. Various cut-offs of umbilical cord blood gas values and lactate values were studied. The main outcomes were mortality before discharge from the neonatal unit and severe neurologic injury defined as grade 3 or 4 periventricular or intraventricular hemorrhage or periventricular leukomalacia. The outcome rates were calculated for various cutoff values of umbilical cord blood gas parameters and were adjusted for birthweight, gestational age, sex, and multiple births. Likelihood ratios were calculated to derive posttest probabilities. A total of 1040 and 1217 neonates had analyzable umbilical cord arterial and venous blood gas values, respectively. In the cohort, the mean (standard deviation) gestational age was 26.5 (1.5) weeks, the mean birthweight was 936 (215) g, the prevalence of mortality was 10% (105/1040), and the prevalence of severe neurologic injury was 9% (92/1016). An umbilical cord arterial pH of ≤7.1 and base excess of ≤-12 mmol/L were associated with >2.5-fold higher posttest probability of mortality, and an umbilical cord arterial or venous lactate value of <3 was associated with a 2.5-fold lower posttest probability of mortality. An umbilical cord arterial lactate value of <3 was associated with a lower posttest probability of severe neurological injury. In preterm neonates of <29 weeks' gestation, low umbilical cord arterial pH and high umbilical cord arterial base excess values were associated with a clinically important increase in the posttest probability of mortality, whereas low umbilical cord arterial or venous lactate values were associated with a decrease in the posttest probability of mortality.

POC Assessment of Umbilical Venous Lactate: A Potential Screening Test for Neonatal Acidosis

Umbilical artery (UA) lactate and pH aid the diagnosis of neonatal acidosis. This study examines the relationship between point-of-care (POC) measurement of umbilical venous (pUVL) lactate and UA lactate and pH to determine whether this POC assessment could serve as an alternative screening modality for neonatal acidosis.

Comparison of Umbilical Arterial and Venous Lactate and Base Excess Values and Its Neonatal Outcome in High-risk Pregnancies

Comparison of Umbilical Arterial and Venous Lactate and Base Excess Values and Its Neonatal Outcome in High-risk Pregnancies

Point‐of‐care assessment of combined umbilical arterial and venous lactate: A potential screening test for neonatal acidosis

To examine the relationship between point-of-care (POC) measurement of combined umbilical arterial and venous (CUAV) lactate and umbilical artery (UA) lactate to determine whether POC assessment of this sample could be an alternative screening modality for neonatal acidosis and aid prediction of neonatal morbidity. In this cross-sectional pilot study, UA and CUAV cord blood samples were collected from live, singleton neonates delivered between June and August 2019, at a tertiary care center. UA samples were analyzed for pH and lactate using a blood gas analyzer. CUAV lactate was also assessed on a blood gas analyzer and at the POC. Linear regression was used to determine the correlation between these samples. A total of 152 neonates were included. There was a statistically significant correlation between CUAV lactate concentrations and UA lactate concentrations (R2 =0.744). Additionally, CUAV lactate concentration measured at the POC was significantly correlated with that measured on a traditional blood gas analyzer (R2 =0.928). POC testing of CUAV lactate is reliable and closely correlated with UA lactate concentrations, making POC testing of CUAV lactate a potential screening test for neonatal acidosis. More data are needed to establish standardization of this test relative to its predictive value in clinical neonatal outcomes.

Reference Values for Umbilical Artery Lactate by Mode of Delivery and Gestational Age: A Retrospective Observational Study

Introduction: Umbilical artery cord blood provides information about the intrauterine metabolism during labor. Umbilical artery lactate is a useful parameter in predicting neonatal morbidity, but data on normal values are limited. We aimed to provide reference ranges of umbilical artery lactate values across the combination of gestational age and mode of delivery. Methods: A single-center retrospective observational study of liveborn infants born between 23 and 42 completed weeks gestation was conducted. Lactate, base deficit (BD), and pH from arterial cord blood were assessed between June 2018 and November 2020 and compared across gestational ages and modes of delivery. Results: Overall, there were 3,353 infants with evaluable data. Lactate values at the 50th, 90th, and 97th percentile were 3.4, 7.0, and 9.0 mmol/L. Lactate was inversely correlated with pH (r = −0.77, p < 0.001) and positively correlated with BD (r = 0.63, p < 0.001). Lactate values changed significantly across gestational age (Kruskal-Wallis test, p < 0.001) which was attributable to an increase in lactate at 39–41 weeks gestational age. Also, lactate values were different across modes of delivery (Kruskal-Wallis test, p < 0.001) with lowest values in elective CS and highest values in vaginal instrumental deliveries. Comprehensive reference ranges across modes of delivery and gestational ages could be established. Discussion: Mode of delivery and gestational age contribute to lactate levels with highest values occurring in vaginal instrumental deliveries and between 39 and 41 weeks gestational age. Based on these observations, we provide detailed reference ranges for clinical use.

Influence of second stage of labor duration on umbilical artery lactate levels in uncomplicated multiparous women

Influence of second stage of labor duration on umbilical artery lactate levels in uncomplicated multiparous women

The Effect of Intrapartum Oxygen Supplementation on Category II Fetal Monitoring

(Am J Obstet Gynecol. 2020;223:905.e1–905.e7) While oxygen is routinely administered in response to category II electronic fetal monitoring (EFM) patterns, there is not currently any evidence that this practice is beneficial for the neonate. Maternal oxygen supplementation in this context is meant to reduce fetal hypoxia, but a recent study suggests umbilical artery lactate was not improved with oxygen supplementation compared with therapy using room air (RA). This was a secondary analysis of that study, aimed at investigating how oxygen supplementation affects other markers of category II EFM.

Umbilical artery lactate levels and associated maternal and newborn characteristics at Mulago National Referral Hospital: a cross-sectional observational study

ObjectiveTo determine the maternal and newborn characteristics associated with high umbilical artery lactate levels at Mulago National Referral Hospital.DesignCross-sectional observational study.SettingDepartment of Obstetrics and Gynecology at a national referral hospital...

642 How does elevated intrauterine resting tone affect the fetus?

More than a third of laboring patients receive an intrauterine pressure catheter (IUPC) for contraction monitoring in labor. Elevated resting intrauterine tone has been hypothesized to decrease uterine perfusion with unknown fetal affect. We assessed the effect of elevated uterine resting tone on neonatal outcomes. This was a secondary analysis of a prospective cohort study of singleton term deliveries between 2010-2014. We included patients with at least 30 minutes of IUPC data prior to delivery. The primary outcome was composite neonatal morbidity (hypoxic ischemic encephalopathy, hypothermia treatment, meconium aspiration syndrome, intubation, mechanical ventilation, seizures, or death). The secondary outcome was umbilical arterial (UA) pH<7.2, lactate ≥ 4 mmol/l, NICU admission, and 5 min APGAR <7. We defined resting tone as the average baseline tone between contractions. Elevated intrauterine tone was ≥ 75th percentile. Multivariable logistic regression and the Zhang method was used to estimate relative risk while adjusting for potential confounders. Of the 8580 patients in the cohort, 2210 (25.8%) had an IUPC and at least 30 mins of pressure data prior to delivery. The majority (98%) of IUPC data were from the second stage. 567 patients had resting intrauterine tone ≥ 12.3 mmHg (≥75th percentile). After adjusting for obesity and chorioamnionitis, elevated resting tone was not associated with increased risk of composite neonatal morbidity (3.5% vs 2.0%, [aRR 1.71 (0.98-2.94)]. However, in a sensitivity analysis of patients in the second stage, elevated resting tone was significantly associated with composite neonatal morbidity [aRR 1.83 (95% CI 1.03-3.15)]. Elevated resting tone was associated with an increased risk of UA pH < 7.2 and UA lactate ≥ 4 [aRR 1.66 (95% CI 1.32-2.07) and 1.32 (95% CI 1.13-1.52)]. Low APGAR scores and NICU admission was similar between groups. The risk of composite neonatal morbidity and acidosis was increased among patients with higher uterine resting tone in the second stage, though the absolute risk was low.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Is Umbilical Cord Arterial Lactate a Predictive Indicator for Assessment of in-Term Neonates Well-being?

Is Umbilical Cord Arterial Lactate a Predictive Indicator for Assessment of in-Term Neonates Well-being?

Umbilical cord arterial and venous gases, ionogram, and glucose level for predicting neonatal morbidity at term

ObjectiveTo determine which parameter of umbilical arterial cord gas analysis, pH, base deficit, lactate concentration, ionogram values, or glucose level index is the best predictor of neonatal morbidity at term. DesignWe conducted a 15-month retrospective cohort study that included all nonanomalous, singleton, term births at a single center. The predictive ability of lactate concentration, base deficit, pH, ionogram values, and glucose level were compared using receiver-operating characteristic curves for global and neurological composite morbidity. Optimal cutoff values for lactate concentration, base deficit, and pH were estimated based on their maximum area under the curve. ResultsWe included 5161 newborns: 52 (1.01 %) had global composite morbidity, and 17 had (0.33 %) neurological composite morbidity. Blood levels of potassium, calcium, natremia, glucose level, and HCO3− did not differ significantly between groups. pH, partial pressure of CO2, partial pressure of O2, base deficit, and lactate levels differed significantly between neonates in the groups with and without global composite morbidity. Nearly similar results were found for neurological composite morbidity. The predictive ability did not differ between arterial pH and arterial lactate concentration (P = .25) and base deficit (P = .79). Optimal cutoff values to predict global composite morbidity were arterial pH 7.144, venous pH 7.236, and arterial lactate concentration 6.5 mmol/L. ConclusionsAcid–base status analysis remains the best objective indicator for predicting neonatal morbidity and can be estimated using pH, lactate, or base deficit. Ionogram cord blood composition and glucose level do not appear to be useful for this purpose.