Umbilical Cord Arterial Lactate Research Articles

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.

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?

Лактат крови артерии пуповины в зависимости от наличия ацидоза у новорожденного

Лактат крови артерии пуповины в зависимости от наличия ацидоза у новорожденного

Elevated umbilical cord arterial lactate at birth and electronic fetal monitoring characteristics on admission and in the active phase.

Objective:To investigate the association between elevated umbilical arterial lactate at birth and electronic fetal monitoring (EFM) characteristics at admission and in the beginning of the active phase of labor.Study Design:Nested case-control study within a prospective cohort of laboring patients at term who achieved active labor. Neonates with umbilical arterial lactate ≥ 4 mmol/L (cases, n=119), were matched 1:1 to controls with lactate <4mmol/L. EFM patterns were compared with multivariable logistic regression.Result:There were no differences in EFM parameters in the first 60 minutes after admission. At the beginning of active labor, 13.5% of cases and 26.1% of controls had always category I tracings, adjusted odds ratio 0.48, 95% confidence interval 0.24-0.94). Cases were less likely to have an always category I tracing from admission into the active phase.Conclusion:Elevated umbilical arterial lactate at birth is associated with distinct EFM patterns early in the labor course.

The comparison of umbilical cord arterial blood lactate and pH values for predicting short-term neonatal outcomes

ObjectiveCurrent clinical practice of assessing neonatal condition is based on evaluation of umbilical cord arterial blood pH value rather than lactate. However, evidence shows that lactate is direct and more predictive measurement than pH or at least of equal importance. This study is to assess and compare umbilical cord arterial lactate and pH values for predicting short-term neonatal outcomes. Materials and methodsA retrospective cohort study was conducted at the tertiary level hospital, were arterial umbilical cord blood sampling was collected according to the standard procedures. Neonatal morbidity was registered if at least one of the following conditions was noted: Apgar score at 1 min after delivery was 6 or lower, resuscitation performed, including assisted ventilation and requirement of admission to neonatal intensive care unit. Mothers–newborns pairs were allocated into two groups: newborns exposed to perinatal hypoxia (group 1) and observed as healthy newborns (group 2). Receiver operating characteristics curves (ROC) were generated to assess the predictive ability of pH and lactate for the short-term neonatal outcomes. Results901 neonates born at ≥37 weeks of gestation were included. Newborns exposed to perinatal hypoxia (group 1) encompassed 39 (4.3%) patients, and observed as healthy (group 2) – 862 (95.7%). Arterial umbilical cord blood pH in group 1 was 7.160 ± 0.126 as compared to 7.314 ± 0.083 in group 2; p < 0.001. Mean arterial lactate was significantly higher in group 1 than group 2 (6.423 ± 2.335 as compared to 3.600 ± 1.833; p < 0.001). The difference between areas under ROC curves representing pH and lactate was not significant (0.848 and 0.831 respectively; p = 0.6132). ConclusionUmbilical cord arterial lactate and pH predicted short-term neonatal outcomes with similar efficacies.

756: Electronic fetal monitoring patterns on admission and in the active phase associated with elevated umbilical cord arterial lactate at term

756: Electronic fetal monitoring patterns on admission and in the active phase associated with elevated umbilical cord arterial lactate at term

293: Electronic fetal monitoring patterns on admission and in the active phase associated with elevated umbilical cord arterial lactate at term

293: Electronic fetal monitoring patterns on admission and in the active phase associated with elevated umbilical cord arterial lactate at term

Umbilical Cord Venous Lactate for Predicting Arterial Lactic Acidemia and Neonatal Morbidity at Term.

To estimate the utility of umbilical venous lactate, more readily available than umbilical cord arterial lactate, for predicting arterial lactic acidemia and neonatal outcomes at term. This was a prospective cohort study of consecutive, nonanomalous, singleton, term births after labor in a large academic medical center (2009-2014). Umbilical arterial and venous lactate were measured immediately after delivery, before knowledge of neonatal outcomes. The outcome measures were arterial lactic acidemia (greater than 3.9 mmol/L) and a composite neonatal outcome consisting of neonatal death and any of a number of neonatal morbidities including intubation, mechanical ventilation, meconium aspiration syndrome, hypoxic-ischemic encephalopathy, and therapeutic hypothermia. Predictive ability of venous lactate was estimated using the area under the receiver operating characteristic curve. Among 7,741 births, venous lactate was strongly predictive of arterial lactic acidemia (area under the curve 0.958). The "optimal" cut point of venous lactate for predicting both arterial lactic acidemia and the composite neonatal outcome was 3.4 mmol/L. This predicted arterial lactic acidemia with sensitivity of 87.0% and specificity of 91.3%. Positive and negative predictive values were 79.9% and 94.7%, respectively. The composite neonatal outcome occurred in 104 neonates (1.3%). Compared with arterial lactate, venous lactate predicted the composite neonatal outcome with comparable sensitivity (75.0% compared with 74.0%, P>.99) but slightly lower specificity (69.7% compared with 72.2%, P<.01). Umbilical venous lactate strongly predicts arterial lactic acidemia and is comparable with arterial lactate for predicting neonatal morbidity at term. It could be used as a measure of neonatal morbidity when arterial blood is not available.

Umbilical Cord Arterial Lactate Compared With pH for Predicting Neonatal Morbidity at Term

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious Issues Collections Obstetric Airway ManagementMaternal EmbolismRegional Anesthesia for Cesarean SectionGeneral Anesthesia for Cesarean SectionAnalgesia for LaborObstetric HemorrhagePre-Eclampsia/EclampsiaPharmacologyTraumaInfection and SepsisMaternal ObesityMaternl Morbidity and MortalityNeonatal Morbidity and MortalityObstetric ComplicationsAnesthetic ComplicationsNon-Obstetric Maternal DiseaseCritical CareDrug Abuse in PregnancyEthicsSystems Based Practice For Authors Information for AuthorsLanguage Editing Services Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search

32: Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term: a prospective cohort study

32: Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term: a prospective cohort study