Point‐of‐care measurement of fetal blood lactate – Time to trust a new device

Wang, Mandy; Chua, Seng Chai; Bouhadir, Lilain; Treadwell, Erin L.; Gibbs, Emma; McGee, Therese

doi:10.1111/ajo.12671

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…However, a negative effect on attentional processes of high blood lactate levels induced with an intravenous infusion of a lactate solution was found [3] and a negative correlation between CSF lactate levels and cognitive capabilities was observed [37][38][39][40]. Moreover, lactate receptors were found in the brain [16] and a role as a neural regulator for lactate was proposed [23].…”

Section: )mentioning

confidence: 99%

Effects of a Bout of Intense Exercise on Some Executive Functions

Coco

Buscemi²,

Guerrera

et al. 2020

IJERPH

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The present study examined the effects of an exhaustive exercise on executive functions by using the Stroop Color Word Test (SCWT), Trail Making Test (TMT), A and B, and simple Reaction Time (RT). Thirty adults agreed to participate; 15 participants had a mean age of 24.7 years ± 3.2 Standard Deviation (SD, Standard Deviation) (group YOUNG), while the remaining 15 had a mean age of 58.9 years ± 2.6 SD (group OLD). Each subject performed the cognitive tasks at rest and blood lactate was measured (pre); each subject executed the acute exhaustive exercise and, immediately after the conclusion, executed the cognitive tasks and blood lactate was again measured (end). Cognitive tests were repeated and blood lactate measured 15 min after its conclusion of the exhaustive exercise (post). We observed: (1) a significant positive correlation between blood lactate levels and RT levels; (2) a significant negative relationship between levels of blood lactate and the SCWT mean score; (3) no significant correlation between blood lactate levels and TMT scores (time and errors), both A and B; (4) variations in blood lactate levels, due to exhaustive exercise, and parallel deterioration in the execution of RT and SCWT are significantly more pronounced in the group YOUNG than in the group OLD. The present study supports the possibility that high levels of blood lactate induced by an exhaustive exercise could adversely affect the executive functions pertaining to the prefrontal cortex.

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Section: )mentioning

confidence: 99%

Effects of a Bout of Intense Exercise on Some Executive Functions

Coco

Buscemi²,

Guerrera

et al. 2020

IJERPH

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“…This is the first study to recommend cutoffs for fetal scalp lactate measured by a POC device to safely rule out hypoxia, with values correlated directly to different neonatal outcomes and predefined combinations of cord blood gases. 5,6,11,14,15 The optimal cutoff lactate value for MA was 5.7 mmol/l but as we aim to prevent rather than to diagnose MA, the suggested cutoff ≥5.2 mmol/l strikes a balance between obtaining the best sensitivity, specificity and negative likelihood ratio for the various neonatal outcomes. A higher cutoff value would result in too low sensitivity for 5 minute Apgar score <7 and for the composite outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Various interventional cutoffs for SSLX have been suggested. However, all are based on relatively small numbers of participants and on conversion equations from the existing accepted cutoffs of LP or pH and not on the neonatal outcome 11,14,15 …”

Section: Introductionmentioning

confidence: 99%

Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study

Iorizzo

Carlsson

Johansson

et al. 2021

BJOG

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Objective Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/l indicating fetal acidosis is exclusive for the point‐of‐care device (POC) LactatePro™, which is no longer in production. The aim of this study was to establish a new cutoff for scalp lactate based on neonatal outcomes with the use of the StatstripLactate®/StatstripXpress® Lactate system, the only POC designed for hospital use. Design Observational study. Setting January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. Population Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks of gestation. Method Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. Main outcome measures Metabolic acidosis in cord blood defined as pH <7.05 plus BDecf >10 mmol/l and/or lactate >10 mmol/l. Results A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. The areas under the receiver operating characteristics curves (AUC) and corresponding optimal cutoff values were as follows; metabolic acidosis AUC 0.87 (95% CI 0.77–0.97), cutoff 5.7 mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68–0.97), cutoff 4.6 mmol/l; pH <7.05 plus BDecf ≥12 mmol/l AUC 0.97 (95% CI 0.92–1), cutoff 5.8 mmol/l; Apgar score <7 at 5 minutes AUC 0.74 (95% CI 0.63–0.86), cutoff 5.2 mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67–0.85), cutoff 4.8 mmol/l. Conclusion A scalp lactate level <5.2 mmol/l using the StatstripLactate®/StatstripXpress® system will safely rule out fetal metabolic acidosis. Tweetable abstract Scalp blood lactate <5.2 mmol/l using the StatstripLactate®/StatstripXpress system has an excellent ability to rule out fetal acidosis.

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“…They are equally calibrated but the StatstripLactate meter has the advantage of being able to transfer data in real time to an electronic medical record system. The performance and accuracy in fetal and adult blood for several POC lactate meters have been published, with SSLX performing with better accuracy and agreement to the stationary blood gas machines (6,(10)(11)(12)(13)(14). It is important to recognize that lactate values vary depending on the POC-lactate-meter used (1,6).…”

Section: Introductionmentioning

confidence: 99%

“…Various interventional cut-offs for SSLX have been suggested. However, all are based on a small number of participants and on conversion equations from the existing accepted cut-offs of LP or pH and not on neonatal outcome (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Proposed cut-off for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a prospective observational study

Iorizzo

Carlsson

Johansson

et al. 2021

Preprint

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Objective Determination of lactate in fetal scalp blood (FBS) during labor has been studied since the 1970s. The internationally accepted cut-off of >4.8mmol/L indicating fetal acidaemia is exclusive for the point-of-care device (POC) LactateProTM, which is no longer in production. The aim of this study was to present a new cut-off for scalp lactate based on neonatal outcomes with the use of StatstripLactate®/StatstripXpress® Lactate system, the only POC lactate meter designed for hospital use. Design Observational Study Setting January 2016 to March 2020 labouring women with an indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. Population Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 gestational weeks. Method Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. Main outcome measures Metabolic acidosis in cord blood was defined as pH <7.05 plus BDecf >10 mmol/L and/or lactate >10 mmol/L. Results 3334 women were enrolled of which 799 were delivered within 25 minutes. The areas under the ROC curves (AUC) and corresponding optimal lactate cut-off values were as follows; metabolic acidosis AUC 0.87(95% CI:0.77-0.97), cut-off 5.7mmol/L; pH <7.0 AUC 0.83(95% CI:0.68-0.97), cut-off 4.6mmol/L; pH <7.05 plus BD ≥12mmol/L AUC 0.97(95% CI:0.92-1), cut-off 5.8mmol/L; Apgar score <7 at 5 minutes AUC 0.74(95% CI:0.63-0.86), cut-off 5.2mmol/L; and pH <7.10 plus composite neonatal outcome AUC 0.76(95% CI:0.67-0.85), cut-off 4.8mmol/L. Conclusions Suggested intervention threshold for fetal acidemia is scalp lactate of 5.2mmol/L using the StatstripLactate®/StatstripXpress®.

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Point‐of‐care measurement of fetal blood lactate – Time to trust a new device

Cited by 11 publications

References 26 publications

Effects of a Bout of Intense Exercise on Some Executive Functions

Effects of a Bout of Intense Exercise on Some Executive Functions

Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study

Proposed cut-off for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a prospective observational study

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