Blood Lactate in the Respiratory Distress Syndrome

Abstract

A NEED EXISTS for some measurement by which the prognosis of infants with respiratory distress syndrome (RDS) can be predicted early in the course of the disease. The concentration of lactate in the blood has been proposed as a determination which may have prognostic significance in RDS with increased concentrations occuring in the most severely involved infants.1,2 It is the purpose of this study to examine the prognostic value of lactate concentrations during the course of the RDS in premature infants. Materials and MethodsThe infants included in this study were born in the Wilford Hall, US Air Force Hospital between October 1963 and December 1964. The pediatric resident present at the deliveries resuscitated the infants and assigned the Apgar ratings. All infants were transferred as soon as possible to the intensive care nursery where they were weighed and placed in an isolette with full humidity and sufficient heat to maintain the body temperature between 96 F and 98 F (35.6 C and 36.7 C). All infants were initially given oxygen at a concentration of 60% to 70%. The oxygen concentration was re¬ duced to 30% to 35% after two to four hours if the infants showed no evidence of respiratory distress. The infants with respiratory distress were maintained at concentrations of oxygen 10% to 20% above that at which cyanosis developed. Pulse, respiration, tone, activity, grunting, retract¬ ing, and color were determined every 15 to 30 minutes until the infant's condition was stable and oxygen was no longer required. All infants were given 1-2 mg of vitamin intramuscularly and silver nitrate eye phophylaxis.The criteria for the diagnosis of respirator}' distress syndrome (RDS) were (1) a resting respiratory rate over 60 per minute, (2) an ex¬ piratory grunt, and (3) chest retractions observed during the first 4 to 6 hours of life and persisting beyond 24 hours of age. Infants with respiratory distress or marked immaturity (birth weight less than 1,500 fm) or both were given a solution con¬ taining glucose, 10 gm/100 ml ; sodium bicarbonate, 66 mEq/liter; and human albumin, 3.75 gm/100 ml intravenously, starting at 1 to 6 hours of age. The larger premature infants with no respiratory distress were given oral feedings at 18 hours of age. The blood samples for lactate determination were taken via a catheter in the umbilical vein. One milliliter of blood was immediately added to 5 ml of 10% trichloracetic acid and frozen until proc¬ essed. Lactate was determined in duplicate by the method of Barker-Summerson3 and pyruvate by the method of Friedemann-Haugan.1 The P02, PCO2 and pH determinations were performed on blood obtained from an umbilical artery with a polarograph (Instrumentation Laboratories) using a Clark Po» electrode and a Severinghaus PCO2 elec¬ trode. The infants were divided into three groups according to the severity of their respiratory distress. The first group (A) had RDS and died. All infants in this group were autopsied and had gross and histologie findings compatible with a diagnosis of RDS or hyaline me...

Agreement between capillary and arterial lactate in the newborn

“…Weil and A showed a decrease in survival from 90 to 10% in a group of 142 adults as lactate rose from 2 to 8 mmol/l (1). Other studies in infants and children have corroborated this observation (3,6,7,19). One infant admitted to our NICU had an initial lactate value of 16 mmol/l and died before inclusion in this study.…”

Agreement between capillary and arterial lactate in the newborn

“…Weil and A showed a decrease in survival from 90 to 10% in a group of 142 adults as lactate rose from 2 to 8 mmol/l (1). Other studies in infants and children have corroborated this observation (3,6,7,19). One infant admitted to our NICU had an initial lactate value of 16 mmol/l and died before inclusion in this study.…”

Early Arterial Lactate and Prediction of Outcome in Preterm Neonates Admitted to a Neonatal Intensive Care Unit

“…After this time point, lactate may be elevated due to causes other than perinatal hypoxia, such as postnatal diseases, e.g. infant respiratory distress syndrome, and hypotension become more prominent [25,26]. CRIB scores have not been developed for the individual prediction of outcome, but have a good NPV [11].…”