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

Abstract

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.

Biomarkers of hypoxic–ischemic encephalopathy: a systematic review

“…Inconsistencies and the reduced number of studies impaired the identification of any metabolite as a putative biomarker. Nevertheless, lactate is a candidate that should be explored in future studies along with new in-depth screenings, considering that it is a systemic severity marker but not neuronal-specific [ 48 ].…”

Association of Umbilical Cord Lactate Levels and Capillary Ph with Hypoxic-Ischemic Encephalopathy in Neonates Born with Intrapartum Asphyxia

“…7 Lactate is an easy and cost-effective marker which can be incorporated into clinical practice to predict poor outcomes, especially hypoxic-ischemic encephalopathy in neonates born with birth asphyxia due to any cause. 8,9 The early neonatal period is very important regarding the overall well-being of the baby. Any event during pregnancy or at the time of birth may adversely affect the health of a neonate, and the treating team needs to be aware of that, especially in the case of high-risk neonates.…”