Cerebrospinal fluid lactate-pyruvate ratio in normal and asphyxiated neonates

Cerebrospinal fluid lactate in 78 cases of adult meningitis

In a retrospective study of 78 cases of adult meningitis, the CSF lactate was measured on the first spinal tap (ST); 25 had a bacterial meningitis, 28 a viral meningitis; 22 other cases had been on antibiotics prior to admission; 3 cases had meningitis of rare aetiology. The median CSF lactate level among the 25 bacterial cases amounted to 13.6 mmol/l (range: 3.5-24.5) whereas it remained low in the 28 viral cases: 2.7 mmol/l (range: 1.4-4.2). These differences are highly significant. The comparison of the CSF lactate level with the other tests routinely performed showed that the CSF lactate level had the highest sensitivity, specificity and predictive values. The CSF lactate level on the first ST had no prognostic value, but a rapid decrease of the CSF lactate during the treatment is indicative of good prognosis. Among the pretreated cases, a high lactate level could be an indication that bacteria were the causal agents. In conclusion, the measurement of the CSF lactate, quickly performed and inexpensive, is worth performing when a meningitis is suspected, as it appears to be the best way of distinguishing bacterial from non-bacterial meningitis.

Predicting neonatal morbidity after perinatal asphyxia: a scoring system

Predicting immediate neonatal morbidity after perinatal asphyxia has been difficult. A review of asphyxiated neonates greater than or equal to 36 weeks' gestation admitted to The Children's Hospital Newborn Intensive Care Unit in 1983 was conducted to devise a scoring system that would rapidly predict organ dysfunction observed in the immediate neonatal period. Comparison of potential score components to morbidity by multiple regression analysis yielded significant association with abnormalities in fetal heart rate monitoring, the 5-minute Apgar score, and neonatal base deficit. A scoring system was devised whose sensitivity (93.8%) and specificity (81.3%) were more predictive than any of its individual components. Prospective analysis in a similar population in 1984 validated its ability to distinguish severe from moderate morbidity after asphyxia. Positive predictive value for the score in the combined study groups (n = 98) was 79% and the negative predictive value was 83%. The scoring system may offer a rapid and accurate prediction of organ dysfunction in the immediate neonatal period after asphyxia.

Cerebrospinal fluid lactate levels in term infants with perinatal hypoxia

The prognostic value of cerebrospinal fluid (CSF) lactate concentration after an hypoxic-ischemic brain insult was evaluated. Three groups of neonates were studied and followed. Group 1A included 19 asphyxiated neonates who subsequently developed normally, Group 1B included 6 asphyxiated neonates who died or developed neurologic sequelae, and Group 2 consisted of 20 control (comparison) infants. A CSF sample was obtained within the first day of life for cytochemical analysis, culture, and lactate determination with simultaneous determination of serum lactate. The mean CSF lactate level in Group 1B (4.5 mmol/L) was significantly higher than in Group 1A (2.5 mmol/L) (p less than .001). In comparison to the highest CSF lactate concentrations in the normal range in Group 2 (2.7 mmol/L), all Group 1B neonates had elevated CSF lactate levels, and eight neonates (34%) of Group 1A had increased levels. A correlation was found between blood and CSF lactate levels in asphyxiated infants (r = .42, p less than .05), but its meaning is uncertain. We conclude that CSF lactate determinations may be helpful in the evaluation of perinatal hypoxic-ischemic encephalopathy.

A familial progressive neurodegenerative disease with 2-oxoglutaric aciduria

A boy and a girl born to a consanguineous Tunisian couple are suffering from a slowly progressive nervous disorder. Initially they both had normal psychomotor development with acquisition of gait and speech. First symptoms in the boy were athetoid movements during the second year of life. He later lost all motor and language skills and developed muscular rigidity and intention tremor. At the age of five years, he was completely bedridden while he appeared mentally much less affected. His younger sister followed a similar course. The major specific abnormality detected was a strikingly elevated excretion of 2-oxoglutaric acid, which was identified by gas liquid chromatography, mass spectrometry, and enzymatic analysis. 2-oxoglutarate dehydrogenase activity in homogenates of cultured skin fibroblasts was reduced to about 25% of control values in both children. Although the pathogenetic mechanisms leading to brain damage remain obscure, the finding strongly suggest an autosomal recessive neurometabolic disease with predominant involvement of the extrapyramidal system.

Improving the long-term outlook in bacterial meningitis

In bacterial and tuberculous meningitis the supply of glucose to the brain seems to be inadequate for its demands which are increased as a consequence of increased cerebral glycolysis. Treatment of patients with glucose infusions to restore cerebrospinal-fluid glucose to normal is therefore indicated.

Cerebrospinal fluid acid-base status and lactate and pyruvate concentrations after short (less than 30 minutes) first febrile convulsions in children

Twenty-nine infants and children with short (less than 30 minutes) first febrile convulsions were studied between 3 and 22 hours after convulsive episodes. Arterial and CSF acid-base variables, lactate and pyruvate concentrations, and lactate/pyruvate ratios were measured. Biochemical signs of cerebral hypoxia were found in only 2 patients, one of whom had short, repeated convulsions. Our findings indicate that hypoxic damage is unlikely to result from a short-duration febrile convulsion.

Respiratory insufficiency syndrome (RIS) in preterm infants with gestational age of 32 weeks and less. Neonatal management and follow-up study

The clinical entity of respiratory insufficiency syndrome (RIS), i.e. irregular breathing leading to recurrent apnea and bradycardia in an otherwise healthy preterm infant, has been studied in respect of symptomathology and management with intensive case including ventilatory support. During a 4-year period 26 of 103 infants with gestational age less than or equal to 32 weeks and mean weight 1304 g (range 710 to 1830 g) developed RIS. In most infants the initial apnea occurred after 2 and before 72 hours post delivery but in some infants later. Because of progressive hypoxemia and acidosis 15 of the 26 RIS infants required IPPV treatment. The 76% survival rate of RIS infants seems to justify intensive care with ventilatory support even in the smallest preterm infants with RIS, especially as the follow-up study performed at 15 months to 3-1/2 years of age showed neurological sequelae in only 3 of 20 surviving babies, i.e. 15% sequelae rate.

Single injection polyfructosan clearance in normal and asphyxiated neonates

The postnatal development of the glomerular filtration rate in 36 neonates has been evaluated by the single injection polyfructosan clearance method (GFRPfr) by studies performed at 0-1, 2-4 and 5-7 weeks of postnatal age. During the first weeks of life there is a rapid postnatal increase of GFRPfr of almost the same magnitude in term and preterm healthy infants. Thus the postnatal development of glomerular filtration rate is more closely related to extra-uterine excretory needs than to the maturatinal stage and gestational age at birth. In the asphyxiated neonates studied the GFRPfr was significantly lowered in the immediate postasphyxial stage while the infants were still hypoxemic. However the postnatal rise of GFRPfr in the time period following the postasphyxial stage was of the same order as in the non-asphyxiated healthy neonates.