Correlação entre a concentração de lactato plasmático e a mortalidade neonatal precoce

Fernandez, Herminia Guimarães Couto; Vieira, Alan Araújo; Barbosa, António

doi:10.1590/s0103-507x2012000200015

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Finally, we included lactate as an index item because it is routinely evaluated via blood gas analysis for neonates as an index of circulatory dynamics. A previous report demonstrated that mortality increased when serum lactate levels exceeded 4.2 mmol/L in neonates with a low GA 20 . Thus, we set the cutoff lactate concentration at >40 mg/dL after consulting with a neonatologist.…”

Section: Discussionmentioning

confidence: 99%

Index for the appropriate vancomycin dosing in premature neonates and infants

Endo

Nemoto

Hanawa

et al. 2021

Pediatrics International

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Background In neonates, vancomycin (VCM) is used to treat Gram‐positive bacterial infections. However, VCM blood concentrations are affected by gestational age, bodyweight (BW), and renal function. The initial VCM dose adjustment can therefore be difficult, and few reports have evaluated this issue. In this study, we investigated the factors determining the appropriate VCM dosing schedule in neonates, especially premature infants. Methods The VCM dosage and trough concentrations were retrospectively investigated from the initial treatment to maintenance therapy in neonatal intensive care unit patients who underwent therapeutic drug monitoring. We examined the average single‐administration VCM dosage during maintenance therapy. We then compared the actual VCM dose with that calculated using an index comprising six items that influence the VCM daily dose (postnatal age, gestational age, BW, serum creatinine level, urine output, and lactate level). Results Twenty premature infants were included. The average BW of patients at the initial VCM administration was 975 g. During maintenance therapy, the average VCM dose was 8.4 mg/kg, and the median trough concentration was 12.4 μg/mL. When we applied the six‐item index, 18 of 20 patients (90%) had concordant results between the actual VCM dosing schedule and the VCM calculated using the index. Conclusions The average VCM dose and six‐item index can facilitate the transition from the initial VCM dose to an appropriate dose in many cases and contribute to early treatment in low‐birthweight infants with more variable BW, distribution volumes, and renal function. In conclusion, our six‐item index may help standardize VCM administration in premature infants.

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Section: Discussionmentioning

confidence: 99%

Index for the appropriate vancomycin dosing in premature neonates and infants

Endo

Nemoto

Hanawa

et al. 2021

Pediatrics International

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Association between Serum Lactate and Morbidity and Mortality in Neonates: A Systematic Review and Meta-Analysis

Matsushita,

Krebs,

De Carvalho

2023

Children

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Objective: Lactate is a marker of hypoperfusion in critically ill patients. Whether lactate is useful for identifying and stratifying neonates with a higher risk of adverse outcomes remains unknown. This study aimed to investigate the association between lactate and morbidity and mortality in neonates. Methods: A meta-analysis was performed to determine the association between blood lactate levels and outcomes in neonates. Ovid MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched from inception to 1 May 2021. A total of 49 observational studies and 14 data accuracy test studies were included. The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the QUADAS-2 tool for data accuracy test studies. The primary outcome was mortality, while the secondary outcomes included acute kidney injury, necessity for renal replacement therapy, neurological outcomes, respiratory morbidities, hemodynamic instability, and retinopathy of prematurity. Results: Of the 3184 articles screened, 63 studies fulfilled all eligibility criteria, comprising 46,069 neonates. Higher lactate levels are associated with mortality (standard mean difference, −1.09 [95% CI, −1.46 to −0.73]). Using the estimated sensitivity (0.769) and specificity (0.791) and assuming a prevalence of 15% for adverse outcomes (median of prevalence among studies) in a hypothetical cohort of 10,000 neonates, assessing the lactate level alone would miss 346 (3.46%) cases (false negative) and wrongly diagnose 1776 (17.76%) cases (false positive). Conclusions: Higher lactate levels are associated with a greater risk of mortality and morbidities in neonates. However, our results do not support the use of lactate as a screening test to identify adverse outcomes in newborns. Research efforts should focus on analyzing serial lactate measurements, rather than a single measurement.

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Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study

et al. 2021

Life

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Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is the most common cause of mortality and neurological disability in infancy after perinatal asphyxia. Reliable biomarkers to predict neurological outcomes of neonates after perinatal asphyxia are still not accessible in clinical practice. Methods: A prospective cohort study enrolled neonates with perinatal asphyxia. Biochemical blood tests and cerebral Doppler ultrasound were measured within 6 h of age and at the 4th day old. Neurological outcomes were assessed at 1 year old. Results: Sixty-four neonates with perinatal asphyxia were enrolled. Fifty-eight (90%) had hypoxic-ischemic encephalopathy (HIE) including 20 (34%) Stage I, 21 (36%) Stage II, and 17 (29%) Stage III. In the asphyxiated infants without therapeutic hypothermia, HIE stage, PH, and base excess levels within 6 h of age were the predictors of adverse outcomes. In the asphyxiated infants receiving therapeutic hypothermia, HIE stage failed to predict outcomes. Instead, blood lactate levels and pulsatility index (PI) of medial cerebral arteries (MCA) either in 6 h of age or at the 4th day old independently predicted adverse outcomes. Conclusions: Blood lactate, which is a common accessible test at the hospital and MCA PI on cerebral ultrasound could predict adverse outcomes in asphyxiated infants receiving therapeutic hypothermia.

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Correlação entre a concentração de lactato plasmático e a mortalidade neonatal precoce

Cited by 4 publications

References 17 publications

Index for the appropriate vancomycin dosing in premature neonates and infants

Index for the appropriate vancomycin dosing in premature neonates and infants

Association between Serum Lactate and Morbidity and Mortality in Neonates: A Systematic Review and Meta-Analysis

Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study

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