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Aim: To investigate the relationship between common acid-base parameters and blood lactate concentrations and their prognostic importance in sick pre-term neonates. Seventy ve serial simultaneous Methods: measurements of arterial acid-base status and serum lactate concentrations were carried out in 30 neonates admitted to NICU with indwelling arterial catheters (gestational age and birthweight, range 27-32 weeks, and 1250-2080 g, respectively. There was a correlat Results: ion that was statistically signicant between arterial blood lactate and pH. (p <0.001). There was no correlation between peak lactate concentration (PLC) and base excess. Lactate concentrations were insensitively indicated by a negative base excess. At all levels, elevated lactate concentrations were associated with increased mortality. In six infants, an increase in blood lactate that was clinically signicant preceded the development of clinical markers of deterioration and complications. pH or base excess cannot be used as surrogate measureme Conclusions: nts for blood lactate concentration; instead, independent measurements of blood lactate concentration are required. In sick neonates, blood lactate concentrations may provide an early warning signal and vital prognostic information. In this regard, serial blood lactate measurements are superior to a single value.