1
|
Kislal FM, Polat CC, Ergül E, Açıkalın AA, Güven D, Gündoğan E, Sarıcı D. Can lactate be valuable in early diagnosis and prognosis of neonatal sepsis? Niger J Clin Pract 2023; 26:1319-1325. [PMID: 37794545 DOI: 10.4103/njcp.njcp_54_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Sepsis monitoring tissue perfusion is crucial for detecting circulatory failure early, implementing the right treatments, and assessing response. Insufficient oxygenation leads to a rise in lactate level and has been shown to be useful in predicting mortality and morbidity in newborns. There have not been many studies on how lactate measurement affects neonatal sepsis diagnosis and prognosis. Aim The aim of our study was to determine the impact of lactate on early diagnosis and prognosis in neonatal sepsis. Materials and Methods Eighty-seven newborns diagnosed with neonatal sepsis at a neonatal intensive care unit between January 2010 and July 2021 were included in the study. Venous blood gas, lactate, and C-reactive protein (CRP) levels and complete blood count on the first, second, and third day of hospitalization were noted. Lactate values were correlated with other variables to determine the impact of hyperlactatemia on morbidity and to determine factors affecting the length of stay. IBM SPSS Statistics version 22.0 for Windows was used to analyze the data (SPSS Inc., Chicago, IL, United States). Results A strong negative correlation between lactate and oxygenation and perfusion indicators (HCO3, BE, PaO2) during the therapeutic process was observed. With treatment, the initial measured lactate value decreased, and a significant increase in CRP and oxygen saturation was observed, which was interpreted as the observation of an early lactate response to infection before a CRP response. The initial lactate level, as well as the change in lactate levels, was not, however, significantly correlated with the length of stay. Conclusion Lactate can be used in the early diagnosis of neonatal sepsis and for determining prognosis.
Collapse
Affiliation(s)
- F M Kislal
- Department of Pediatrics, University of Health and Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - C C Polat
- Department of Pediatrics, University of Health and Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - E Ergül
- Department of Pediatrics, University of Health and Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - A A Açıkalın
- Department of Pediatrics, University of Health and Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - D Güven
- Department of Pediatrics, University of Health and Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - E Gündoğan
- Department of Pediatrics, University of Health and Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - D Sarıcı
- Department of Neonatology, University of Health and Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
2
|
Iorizzo L, Carlsson Y, Johansson C, Berggren R, Herbst A, Wang M, Leiding M, Isberg PE, Kristensen K, Wiberg-Itzel E, McGee T, Wiberg N. Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study. BJOG 2021; 129:636-646. [PMID: 34555249 DOI: 10.1111/1471-0528.16924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- L Iorizzo
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden
| | - Y Carlsson
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - C Johansson
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden
| | - R Berggren
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Herbst
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - M Wang
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - M Leiding
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Skåne, Sweden
| | - P-E Isberg
- Department of Statistics, Lund University, Lund, Sweden
| | - K Kristensen
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - E Wiberg-Itzel
- Department of Obstetrics and Gynaecology, Söder Hospital, Stockholm, Sweden.,Institute of Karolinska, Stockholm, Sweden
| | - T McGee
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - N Wiberg
- Department of Obstetrics and Gynaecology, Ystad lasarett, Ystad, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| |
Collapse
|
3
|
Rajala K, Mönkkönen A, Saarelainen H, Keski-Nisula L. Fetal lactate levels align with the stage of labour. Eur J Obstet Gynecol Reprod Biol 2021; 261:139-143. [PMID: 33934025 DOI: 10.1016/j.ejogrb.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the association between lactate concentrations in fetal blood samples and the different advanced labour stages. METHODS Eighteen-month prospective population-based clinical study of 187 singleton pregnant women in labour who were monitored by fetal blood sampling (FBS) because of non-reassuring intrapartum CTG results at Kuopio University Hospital, Finland. Peripheral lactate concentration and pH were analysed at different stages of labour and in umbilical arterial samples immediately after delivery. RESULTS FBS samples (N = 350) were obtained from 5.4 % of all women in labour during the study period, and 48 % had spontaneous delivery, 27 % had vacuum-assisted vaginal delivery, and 25 % had nonelective Caesarean delivery. FBS lactate levels increased 4-11% with every 1-2 cm of cervical dilation and 18 % from early labour to fully dilated cervix. In 42 women with at least two FBSs, lactate levels increased significantly from the early I stage of labour and up to a fully dilated cervix. Lactate values were significantly higher in umbilical arterial samples compared to FBSs. Sensitivity of the highest FBS lactate values for the detection of birth asphyxia were considerably low varying between 42.9-57.1%. CONCLUSION FBS lactate levels were related to the stage of labour during vaginal delivery attempt. Wide range of lactate levels during labour complicates its use as a predictor of birth asphyxia.
Collapse
Affiliation(s)
- K Rajala
- Department of Clinical Genetics, Kuopio University Hospital, Kuopio, Finland
| | - A Mönkkönen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - H Saarelainen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - L Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|
4
|
West S, Ibiebele I, Nippita T. Intrapartum fetal blood sampling performed at early cervical dilatation and delivery outcomes. Aust N Z J Obstet Gynaecol 2020; 61:403-407. [PMID: 33382081 DOI: 10.1111/ajo.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intrapartum fetal blood sampling (FBS) is a fetal well-being diagnostic test for cardiotocogram abnormalities. AIM The aim of this study was to determine whether women who had their first FBS at <4 cm cervical dilation had an increased risk of operative delivery (caesarean section, instrumental delivery) compared to those women who had their first FBS ≥ 4 cm dilation. MATERIALS AND METHODS Retrospective cohort study involving labouring women who underwent FBS in a tertiary centre between 2015 and 2017. Women who had their first FBS at <4 cm dilation were compared to those who had their first FBS at ≥4 cm. The primary outcome was operative delivery (caesarean, instrumental delivery); secondary outcomes were neonatal complications. Univariate logistic regression was used to assess the association between degree of cervical dilation at first FBS and study outcomes. RESULTS Among 591 women, 39 (6.6%) had their first FBS at <4 cm cervical dilation. Women in the ≥4 cm group were less likely to have a total of ≥2 FBS (P = 0.003). There was no difference in the primary outcome between the two groups. Women who had the first FBS at <4 cm dilation were twice as likely to have a caesarean section delivery (odds ratio 2.06, 95% confidence interval 1.06-3.98), although 41% had a vaginal birth (instrumental and spontaneous). There were no differences in rates of resuscitation or admission to nursery between groups. CONCLUSION Women who had their first FBS < 4cm cervical dilation were twice as likely to have a caesarean section compared to women who had their first FBS ≥ 4 cm. However, 41% had a vaginal birth, and there were no differences in fetal outcomes.
Collapse
Affiliation(s)
- Simon West
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Sydney Medical School - Northern, The University of Sydney, Sydney, New South Wales, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Ibinabo Ibiebele
- Sydney Medical School - Northern, The University of Sydney, Sydney, New South Wales, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Tanya Nippita
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Sydney Medical School - Northern, The University of Sydney, Sydney, New South Wales, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| |
Collapse
|
5
|
Shakouri F, Iorizzo L, Edwards HMK, Vinter CA, Kristensen K, Isberg PE, Wiberg N. Effectiveness of fetal scalp stimulation test in assessing fetal wellbeing during labor, a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:347. [PMID: 32503518 PMCID: PMC7275571 DOI: 10.1186/s12884-020-03030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess fetal wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test. METHODS A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level < 4.2 mmol/L in scalp blood and arterial cord pH > 7.1 were cut-offs for normality. RESULTS Three hundred eighty-five women were included. The cohort was divided by the FBS-to-delivery time: Group 1 (n = 128) ≤ 20 min, Group 2 (n = 117) 21-59 min and Group 3 (n = 140) ≥ 60 min. The proportion of FSS-positive tests differed significantly between the groups (p < 0.000). In Group 1 the sensitivity, specificity and likelihoods for scalp lactate ≥4.2 mmol/L were 81.5 (95% CI 67-90.1), 13.3 18.5 (95% CI 5.9-24.6), LHR+ 0.94 (95% CI 0.8-1.1) and LHR - 1.4 (95% CI 0.6-3.2) and for umbilical artery pH ≤ 7.10 the values were 82.6% (95% CI 61.2-95.1), 16% (95% CI 9.4-24.7), 1.0 (95% CI 0.8-1.2) and 1.1 (95% CI 0.4-3) respectively. Regardless of the FBS-to-delivery time the LHR+ for lactate ≥4.2 mmol/L increased to 1.38 (95% CI 1.2-1.6). CONCLUSION The effectiveness of scalp stimulation test was poor for both ruling in and out fetal hypoxia during labor. Absence of a provoked acceleration seems to be a normal phenomenon in the second stage of labor.
Collapse
Affiliation(s)
- Farzaneh Shakouri
- Department of Gynecology and Obstetrics, Sjælland University Hospital, Roskilde, Denmark
| | - Linda Iorizzo
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Gynecology and Obstetrics, Helsingborg Hospital, Helsingborg, Sweden.
| | - Hellen Mc Kinnon Edwards
- Department of Gynecology and Obstetrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Anne Vinter
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karl Kristensen
- Department of Clinical Sciences Lund, Gynecology and Obstetrics, Lund University, Faculty of Medicine, Lund, Sweden
| | | | - Nana Wiberg
- Department of Clinical Sciences Lund, Gynecology and Obstetrics, Lund University, Faculty of Medicine, Lund, Sweden
- Department of Gynecology and Obstetrics, Skåne University Hospital, Ystad, Sweden
| |
Collapse
|
6
|
Mattersberger C, Schmölzer GM, Urlesberger B, Pichler G. Blood Glucose and Lactate Levels and Cerebral Oxygenation in Preterm and Term Neonates-A Systematic Qualitative Review of the Literature. Front Pediatr 2020; 8:361. [PMID: 32903733 PMCID: PMC7438789 DOI: 10.3389/fped.2020.00361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Cerebral oxygenation monitored non-invasively by near-infrared spectroscopy (NIRS) is of increasing interest in neonatal care. Cerebral oxygenation is determined by cerebral oxygen delivery and cerebral oxygen consumption. Oxygen delivery as well as oxygen consumption might be influenced by metabolic parameters like blood glucose and lactate. Objective: The aim of the present systematic qualitative review is therefore to identify and summarize all studies, which describe cerebral oxygenation measured with NIRS and blood glucose and/or blood lactate levels in neonates. Data sources: A systematic search of Ovid Embase and PubMed was performed. Search terms included near-infrared spectroscopy, fractional tissue oxygen extraction, cerebral tissue oxygen saturation, regional cerebral tissue oxygen saturation, oxygenation, term, and preterm neonates, cesarean delivery, transition, after-birth, newborn, vaginal delivery, cesarean delivery, baby, neonatal transition, metabolism, lactate, glucose, and blood glucose level. Study selection/data synthesis: Studies analyzing cerebral oxygenation and blood glucose and/or blood lactate levels in neonates were included. Animal studies, duplicates, or studies in non-English language were excluded. Results: Twenty-five studies were identified that describe blood glucose and/or blood lactate levels as primary or secondary outcome parameters with additional measured cerebral oxygenation by NIRS in neonates. Twelve studies were included with blood glucose measurements: four described an association between blood glucose levels and cerebral oxygenation, two show no association, and six do not report on possible associations. Eighteen studies were included with lactate measurements: one describe an association between lactate levels and cerebral oxygenation, while three show no association and 14 do not report on possible associations. Discussion: The influence of blood glucose and blood lactate levels on the cerebral oxygenation in neonates is still controversial. However, there seems to be an association between cerebral oxygenation and the metabolic parameter blood glucose and lactate, which need further investigation.
Collapse
Affiliation(s)
- Christian Mattersberger
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Graz, Austria
| |
Collapse
|
7
|
Demaegd HMI, Bauters EGR, Page GH. Foetal scalp blood sampling and ST-analysis of the foetal ECG for intrapartum foetal monitoring: a restricted systematic review. Facts Views Vis Obgyn 2019; 11:337-346. [PMID: 32322830 PMCID: PMC7162663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To investigate if foetal scalp blood sampling (FBS) is useful in preventing foetal metabolic acidosis in labour when ST-analysis of the foetal ECG (STAN ® ) is already being used as a second line technique for intrapartum foetal monitoring with cardiotocography (CTG). DESIGN Restricted systematic review. METHODS Based on a literature search in July 2019, a restricted systematic review was performed. Studies comparing CTG+STAN ® +FBS with CTG+STAN ® , CTG+FBS or CTG only were included. Observational studies allowing FBS in addition to STAN ® reporting the indications, results and neonatal outcomes were included as well. RESULTS Five randomised controlled trials (RCT) and seven observational trials were analysed. Based on the analysis of data coming from one RCT, FBS identifies foetal acidosis in 9.9% when performed in specific situations. Similarly, in observational trials it was found that in up to 10% of cases where STAN ® registration was less reliable, FBS suggested foetal acidosis. However, there is no evidence that FBS in these cases was capable of preventing metabolic acidosis or its neurological consequences. CONCLUSION Based on the available literature, no recommendations in favour of combining FBS with STAN ® monitoring can be made.
Collapse
Affiliation(s)
- HMI Demaegd
- Jan Yperman Ziekenhuis, Department Gynaecology and Obstetrics, Briekestraat 12, 8900 Ieper
| | - EGR Bauters
- Jan Yperman Ziekenhuis, Department Gynaecology and Obstetrics, Briekestraat 12, 8900 Ieper
| | - GH Page
- Jan Yperman Ziekenhuis, Department Gynaecology and Obstetrics, Briekestraat 12, 8900 Ieper
| |
Collapse
|