The Significance of Lactate Values in Preterm Infants Les Than 32 Weeks Gestation

Background: reliable measurements of lactate as well as blood gas values have become available in the setting of neonatal care. We aimed to present serum lactate and lactate clearance rate as impprtant prognostic indicators in critically ill preterm infants. Methods: This is a retrospective study of 73 preterm infants less than 32 weeks gestation admitted to neonatal intensive care units. Preterm infants were excluded if they had a known lethal abnormalities and/or structural heart abnormality. All capillary blood gases obtained during the first 84 h of life in the range of 4-6 samples per day according to the condition of the patients were retrievedfrim patient s records, and a lactate value was available for each sample and accordingly lactate clearance rate was calculated. Cranial u/s was performed within the first 84 h of life. The adverse outcome was defined as death within the first week of life, severe intraventricular hemorrhage on cranial ultrasonography. Results: There were 73 patients admitted over 12 months period from June 2011 to May 2012, 37 males and 36 females The mean gestational age of the studied neonates was 29.48 ± 1.36 weeks, with mean body weight of 1205.34 ± 230.37 grams. Blood lactate level ranged from 8.00 - 152.00 mg /dl with mean value of 24.52 ± 18.98 and lactate clearance rate was negative at 24hours, 48 hours, and 84 hours and positive at 72 hours and 95% confidence interval at 24hour, 48 hours, 72 hours and 84 hours were (-31.521 to - 0.178, - 0.777 to - 0.198, - 0.551 to 0.066 and 0.386 to 1.295,) being significant at 24 hours, 48 hours, 84 hours, and not significant 72: hours. Intracranial hemorrhage was significantly correlated with increased blood lactate at 1 hour, 8 hours, 24 hours, 36 hours, 48 hours, 60 hours, 72 hours and 84 hours. Mortality was significantly correlated with increased blood lactate at 60 hours, 72 hours, and 84 hours. Conclusion: Serial persistent increased lactate measurements and low lactate clearance rate predict adverse outcome and may aid the clinician in bedside decision making.