Hyperlactatemia in Neonates Admitted to the Cardiac Intensive Care Unit with Critical Heart Disease

Abstract

Neonates with critical heart disease are at risk of significant deficiencies in systemic oxygen delivery. The incidence and clinical pattern of hyperlactatemia in neonates presenting with critical heart disease has not been described. We reviewed the lactate pattern of neonates transferred to our cardiac intensive care unit for surgical management of their heart disease over a 1-year period. Stabilization of these neonates began in the referring institutions. From 8/4/03 to 8/4/04, 75 neonates with critical heart disease were transferred to our unit for stabilization and subsequent surgery. Blood lactate was measured on admission and subsequently in any patient thought to be at risk of low systemic oxygen delivery. Lactate was measured in 59 patients on admission and in 63 patients within the first 48 h of admission. Median age on admission was 1 day (range 0–13). Median age at surgery was 8 days (range 1–30). Median length of stay was 20 days. Peak lactate was noted on admission in 51 patients, and at 12–24 h in 8 patients. Mild hyperlactatemia (2.3–5 mmol/l) was present in 30 patients on admission and moderate-to-severe hyperlactatemia (≧5 mmol/l) was present in 8 patients. Mean lactate level on admission was 3.1 ± 0.6 mmol/l, and this did not return to normal (<2.3 mmol/l) until 36 h after admission. Severe hyperlactatemia patients also were noted to have normal lactate levels by 36 h. The presence of hyperlactatemia did not affect length of stay or mortality. There were no preoperative deaths and 4 postoperative deaths (1 death in 38 patients with mild or severe hyperlactatemia). Hyperlactatemia is frequently present in neonates admitted to a tertiary care center for management of congenital heart disease. Blood lactate levels normalize within 36 h. The presence of preoperative hyperlactatemia, even when moderate-to-severe, does not have significant adverse effect on postoperative mortality.

Hyperlactatemia and Patient Outcomes After Pediatric Cardiac Surgery

“…In anaerobic metabolism, pyruvate is converted into lactic acid by lactate dehydrogenase; this lactic acid is considered a by-product of glycolysis and is used during the Cori cycle in the liver. 2 Although the primary organ responsible for lactate clearance is the liver, the kidneys also provide clearance when lactate levels are increased in the body. Two forms of lactic acid exist: D-lactate and L-lactate.…”

Biomarkers and Clinical Tools in Critically ill Children: Are we Heading Toward Tailored Drug Therapy?

“…Predominantly, patients with CHD were studied, but there are also reports on children with septic shock, traumatic brain injury, acute severe asthma, mitochondrial disease and therapyresistant cardiorespiratory failure requiring extracorporeal membrane oxygenation . Lactate levels expressed as changes over time might be more interesting than absolute levels [27,28,[31][32][33]36,37,39,43,44,50].…”