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The Relationship between the Lactate Level of Umbilical Cord Blood with Early Neonatal Complications
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Nayereh Ghomian1    , Elahe Zandieh2 , Mostafa Zemorshidi3 , Majid Khadem-Rezaiyan 4 |
1- Professor of Gynecology, Department of Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2- Resident of Gynecology, Department of Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3- Medical Doctorate, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4- Assistant Professor of Community Medicine, Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. , khademrm@mums.ac.ir |
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Abstract: (818 Views) |
Background and Aim: Most studies showed that low cord blood pH was associated with short-term mortality as well as long-term neurological disorders, but few studies showed associations between high cord blood lactate and adverse short-term outcomes. This study aimed to determine the association between umbilical cord blood lactate during the first hour of birth in infants with 5th-minute Apgar scores <7 and short-term neonatal complications.
Materials and Methods: In this cross-sectional study, 49 pregnant women over 37 weeks gestation referred to the maternity wards of Academic Hospitals of the Mashhad university of medical sciences with the onset of labor, whose neonates scored below 7 in 5th-minute Apgar, were included after obtaining informed consent, by convenient sampling method. Preliminary information was recorded. Also, a blood sample was taken from the umbilical artery and its pH, pCO2, bicarbonate, and lactate levels were measured. The neonatal outcomes and complications and outcomes (discharge or infant death) were evaluated.
Results: Overall, 25 male (51.0%) and 24 female neonates (49.0%) with a mean gestational age of 39.3±1.1 weeks were studied. Cord blood lactate concentrations were significantly higher in neonates with hypoxic-ischemic encephalopathy, intubation-ventilation, hypothermia, meconial aspiration, NICU admission, and those who died compared with the opposite groups (P<0.05). The best lactate cut-off point for predicting hypoxic ischemic encephalopathy and intubation was 4.55mg/dl, while for predicting neonatal death it was 6.19mg/dl with 100% sensitivity and 97.4% specificity.
Conclusion: Umbilical cord blood lactate measurement can be a highly accurate measure of neonatal outcome and early complications that can greatly help with the health status assessments of infants with adverse Apgar scores at birth, their prognosis, and management.
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| Keywords: Umbilical cord blood, Lactate, Neonatal complication, Apgar |
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Full-Text [PDF 930 kb]
(295 Downloads)
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Type of Study: Original Research |
Subject:
Medicine - Obstetrics and Gynecology
Received: 2022/02/3 | Accepted: 2022/07/12 | Published: 2023/03/15
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1. رفرنس های متنی مثل خروجی کراس رف را در اینجا وارد کرده و تایید کنید
Heidarzadeh M, Fayyazi A, Abdollahi-Fard S, Gheshlag Soflaei Z, Shabanloei R, Ahmadi F, et al. Relationship between Blood Cord Analysis at Delivery Time and Outcome of Resuscitated Neonates. Med J Tabriz Uni Med Sciences Health Services. 2010;32(4):27-32. 2. Andreani M, Locatelli A, Assi F, Consonni S, Malguzzi S, Paterlini G, et al. Predictors of umbilical artery acidosis in preterm delivery. American J of Obstet Gynecol. 2007;197(3):303.e1-e5. [ DOI:10.1016/j.ajog.2007.07.009] [ PMID] 3. Yeh P, Emary K, Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51 519 consecutive validated samples. BJOG: An Int J of Obstet and Gynecol. 2012;119(7):824-31. [ DOI:10.1111/j.1471-0528.2012.03335.x] [ PMID] 4. White CR, Doherty DA, Henderson JJ, Kohan R, Newnham JP, Pennell CE. Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit. The Australian & New Zealand J of Obstet and Gynecol. 2010;50(4):318-28. [ DOI:10.1111/j.1479-828X.2010.01192.x] [ PMID] 5. Pediatrics AAo. Neonatal Encephalopathy and Neurologic Outcome, Second EditionReport of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy. Pediatrics. 2014;133(5):e1482-e8. [ DOI:10.1542/peds.2014-0724] 6. Labrecque L, Provençal M, Caqueret A, Wo BL, Bujold E, Larivière F, et al. Correlation of cord blood pH, base excess, and lactate concentration measured with a portable device for identifying fetal acidosis. J of Obstet and Gynecol Canada. 2014;36(7):598-604. [ DOI:10.1016/S1701-2163(15)30539-9] [ PMID] 7. Orsonneau J-L, Fraissinet F, Sébille-Rivain V, Dudouet D, Bigot-Corbel E. Suitability of POC lactate methods for fetal and perinatal lactate testing: considerations for accuracy, specificity and decision making criteria. Clin Chem and Lab Med (CCLM). 2013;51(2):397-404. [ DOI:10.1515/cclm-2012-0201] [ PMID] 8. Romanov AY, Prikhodko AM, Tysyachnyi OV, Baev OR, Yarotskaya EL, Sukhikh GT. Comparison of cord blood lactate measurement by gas analyzer and portable electrochemical devices. J of Perinatal Med. 2020;48(2):157-61. [ DOI:10.1515/jpm-2019-0357] [ PMID] 9. Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, et al. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp Ther Med. 2021;21(1):80. [ DOI:10.3892/etm.2020.9513] [ PMID] [ ] 10. Allanson ER, Waqar T, White C, Tunçalp Ö, Dickinson JE. Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review. Int J of Obstet and Gynecol. 2017;124(4):584-94.
https://doi.org/10.1097/01.aoa.0000527016.07972.b8 [ DOI:10.1111/1471-0528.14306] 12. Ross MG, Gala R. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. Am J Obstet Gynecol. 2002;187(1):1-9. [ DOI:10.1067/mob.2002.123204] [ PMID] 13. Goldaber KG, Gilstrap LC, 3rd, Leveno KJ, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol. 1991;78(6):1103-7. 14. Tuuli MG, Stout MJ, Shanks A, Odibo AO, Macones GA, Cahill AG. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol. 2014;124(4):756-61. [ DOI:10.1097/AOG.0000000000000466] [ PMID] [ ] 15. Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, et al. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp and Ther Med. 2021;21(1):1. [ DOI:10.3892/etm.2020.9513] [ PMID] [ ] 16. Allanson ER, Grobicki K, Pattinson RC, Dickinson JE. Attitudes towards the implementation of universal umbilical artery lactate analysis in a South African district hospital. BMC pregnancy and childbirth. 2016;16(1):166. [ DOI:10.1186/s12884-016-0968-y] [ PMID] [ ] 17. Racinet C, Richalet G, Corne C, Faure P, Peresse JF, Leverve X. [Diagnosis of neonatal metabolic acidosis by eucapnic pH determination]. Gynecologie, obstetrique & fertilite. 2013;41(9):485-92. [ DOI:10.1016/j.gyobfe.2013.07.020] [ PMID] 18. Mazouri A, Fallah R, Saboute M, Taherifard P, Dehghan M. The prognostic value of the level of lactate in umbilical cord blood in predicting complications of neonates with meconium aspiration syndrome. J Matern Fetal Neonatal Med. 2021;34(7):1013-9. [ DOI:10.1080/14767058.2019.1623195] [ PMID] 19. Tuuli MG, Stout MJ, Macones GA, Cahill AG. Umbilical cord venous lactate for predicting arterial lactic acidemia and neonatal morbidity at term. Obstet and Gynecol. 2016;127(4):674. [ DOI:10.1097/AOG.0000000000001339] [ PMID] [ ] 20. Kumar N, Yadav A. Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy. CEGH. 2020;8(3):927-33. [ DOI:10.1016/j.cegh.2020.02.026] 21. Patil SS, Rath S, George CE. Study on umbilical cord arterial blood gas analysis and cord blood lactate levels as predictors for adverse neonatal outcome: an observational study. IJRCOG 2018;7(4):1494-501. [ DOI:10.18203/2320-1770.ijrcog20181342] 22. Einikyte R, Snieckuviene V, Ramasauskaite D, Panaviene J, Paliulyte V, Opolskiene G, Kazenaite E. The comparison of umbilical cord arterial blood lactate and pH values for predicting short-term neonatal outcomes. Taiwanese J of Obstet and Gynecol. 2017;56(6):745-9. [ DOI:10.1016/j.tjog.2017.10.007] [ PMID] 23. Heidarzadeh M, Fayyazi A, Abdollahi-Fard S, Gheshlag Soflaei Z, Shabanloei R, Ahmadi F, et al. Relationship between Blood Cord Analysis at Delivery Time and Outcome of Resuscitated Neonates. Med J Tabriz Uni Med Sciences Health Services. 2010;32(4):27-32. 24. Andreani M, Locatelli A, Assi F, Consonni S, Malguzzi S, Paterlini G, et al. Predictors of umbilical artery acidosis in preterm delivery. American J of Obstet Gynecol. 2007;197(3):303.e1-e5. [ DOI:10.1016/j.ajog.2007.07.009] [ PMID] 25. Yeh P, Emary K, Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51 519 consecutive validated samples. BJOG: An Int J of Obstet and Gynecol. 2012;119(7):824-31. [ DOI:10.1111/j.1471-0528.2012.03335.x] [ PMID] 26. White CR, Doherty DA, Henderson JJ, Kohan R, Newnham JP, Pennell CE. Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit. The Australian & New Zealand J of Obstet and Gynecol. 2010;50(4):318-28. [ DOI:10.1111/j.1479-828X.2010.01192.x] [ PMID] 27. Pediatrics AAo. Neonatal Encephalopathy and Neurologic Outcome, Second EditionReport of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy. Pediatrics. 2014;133(5):e1482-e8. [ DOI:10.1542/peds.2014-0724] 28. Labrecque L, Provençal M, Caqueret A, Wo BL, Bujold E, Larivière F, et al. Correlation of cord blood pH, base excess, and lactate concentration measured with a portable device for identifying fetal acidosis. J of Obstet and Gynecol Canada. 2014;36(7):598-604. [ DOI:10.1016/S1701-2163(15)30539-9] [ PMID] 29. Orsonneau J-L, Fraissinet F, Sébille-Rivain V, Dudouet D, Bigot-Corbel E. Suitability of POC lactate methods for fetal and perinatal lactate testing: considerations for accuracy, specificity and decision making criteria. Clin Chem and Lab Med (CCLM). 2013;51(2):397-404. [ DOI:10.1515/cclm-2012-0201] [ PMID] 30. Romanov AY, Prikhodko AM, Tysyachnyi OV, Baev OR, Yarotskaya EL, Sukhikh GT. Comparison of cord blood lactate measurement by gas analyzer and portable electrochemical devices. J of Perinatal Med. 2020;48(2):157-61. [ DOI:10.1515/jpm-2019-0357] [ PMID] 31. Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, et al. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp Ther Med. 2021;21(1):80. [ DOI:10.3892/etm.2020.9513] [ PMID] [ ] 32. Allanson ER, Waqar T, White C, Tunçalp Ö, Dickinson JE. Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review. Int J of Obstet and Gynecol. 2017;124(4):584-94.
https://doi.org/10.1097/01.aoa.0000527016.07972.b8 [ DOI:10.1111/1471-0528.14306] 34. Ross MG, Gala R. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. Am J Obstet Gynecol. 2002;187(1):1-9. [ DOI:10.1067/mob.2002.123204] [ PMID] 35. Goldaber KG, Gilstrap LC, 3rd, Leveno KJ, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol. 1991;78(6):1103-7. 36. Tuuli MG, Stout MJ, Shanks A, Odibo AO, Macones GA, Cahill AG. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol. 2014;124(4):756-61. [ DOI:10.1097/AOG.0000000000000466] [ PMID] [ ] 37. Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, et al. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp and Ther Med. 2021;21(1):1. [ DOI:10.3892/etm.2020.9513] [ PMID] [ ] 38. Allanson ER, Grobicki K, Pattinson RC, Dickinson JE. Attitudes towards the implementation of universal umbilical artery lactate analysis in a South African district hospital. BMC pregnancy and childbirth. 2016;16(1):166. [ DOI:10.1186/s12884-016-0968-y] [ PMID] [ ] 39. Racinet C, Richalet G, Corne C, Faure P, Peresse JF, Leverve X. [Diagnosis of neonatal metabolic acidosis by eucapnic pH determination]. Gynecologie, obstetrique & fertilite. 2013;41(9):485-92. [ DOI:10.1016/j.gyobfe.2013.07.020] [ PMID] 40. Mazouri A, Fallah R, Saboute M, Taherifard P, Dehghan M. The prognostic value of the level of lactate in umbilical cord blood in predicting complications of neonates with meconium aspiration syndrome. J Matern Fetal Neonatal Med. 2021;34(7):1013-9. [ DOI:10.1080/14767058.2019.1623195] [ PMID] 41. Tuuli MG, Stout MJ, Macones GA, Cahill AG. Umbilical cord venous lactate for predicting arterial lactic acidemia and neonatal morbidity at term. Obstet and Gynecol. 2016;127(4):674. [ DOI:10.1097/AOG.0000000000001339] [ PMID] [ ] 42. Kumar N, Yadav A. Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy. CEGH. 2020;8(3):927-33. [ DOI:10.1016/j.cegh.2020.02.026] 43. Patil SS, Rath S, George CE. Study on umbilical cord arterial blood gas analysis and cord blood lactate levels as predictors for adverse neonatal outcome: an observational study. IJRCOG 2018;7(4):1494-501. [ DOI:10.18203/2320-1770.ijrcog20181342] 44. Einikyte R, Snieckuviene V, Ramasauskaite D, Panaviene J, Paliulyte V, Opolskiene G, Kazenaite E. The comparison of umbilical cord arterial blood lactate and pH values for predicting short-term neonatal outcomes. Taiwanese J of Obstet and Gynecol. 2017;56(6):745-9. [ DOI:10.1016/j.tjog.2017.10.007] [ PMID] 45. Heidarzadeh M, Fayyazi A, Abdollahi-Fard S, Gheshlag Soflaei Z, Shabanloei R, Ahmadi F, et al. Relationship between Blood Cord Analysis at Delivery Time and Outcome of Resuscitated Neonates. Med J Tabriz Uni Med Sciences Health Services. 2010;32(4):27-32. 46. Andreani M, Locatelli A, Assi F, Consonni S, Malguzzi S, Paterlini G, et al. Predictors of umbilical artery acidosis in preterm delivery. American J of Obstet Gynecol. 2007;197(3):303.e1-e5. [ DOI:10.1016/j.ajog.2007.07.009] [ PMID] 47. Yeh P, Emary K, Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51 519 consecutive validated samples. BJOG: An Int J of Obstet and Gynecol. 2012;119(7):824-31. [ DOI:10.1111/j.1471-0528.2012.03335.x] [ PMID] 48. White CR, Doherty DA, Henderson JJ, Kohan R, Newnham JP, Pennell CE. Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit. The Australian & New Zealand J of Obstet and Gynecol. 2010;50(4):318-28. [ DOI:10.1111/j.1479-828X.2010.01192.x] [ PMID] 49. Pediatrics AAo. Neonatal Encephalopathy and Neurologic Outcome, Second EditionReport of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy. Pediatrics. 2014;133(5):e1482-e8. [ DOI:10.1542/peds.2014-0724] 50. Labrecque L, Provençal M, Caqueret A, Wo BL, Bujold E, Larivière F, et al. Correlation of cord blood pH, base excess, and lactate concentration measured with a portable device for identifying fetal acidosis. J of Obstet and Gynecol Canada. 2014;36(7):598-604. [ DOI:10.1016/S1701-2163(15)30539-9] [ PMID] 51. Orsonneau J-L, Fraissinet F, Sébille-Rivain V, Dudouet D, Bigot-Corbel E. Suitability of POC lactate methods for fetal and perinatal lactate testing: considerations for accuracy, specificity and decision making criteria. Clin Chem and Lab Med (CCLM). 2013;51(2):397-404. [ DOI:10.1515/cclm-2012-0201] [ PMID] 52. Romanov AY, Prikhodko AM, Tysyachnyi OV, Baev OR, Yarotskaya EL, Sukhikh GT. Comparison of cord blood lactate measurement by gas analyzer and portable electrochemical devices. J of Perinatal Med. 2020;48(2):157-61. [ DOI:10.1515/jpm-2019-0357] [ PMID] 53. Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, et al. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp Ther Med. 2021;21(1):80. [ DOI:10.3892/etm.2020.9513] [ PMID] [ ] 54. Allanson ER, Waqar T, White C, Tunçalp Ö, Dickinson JE. Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review. Int J of Obstet and Gynecol. 2017;124(4):584-94.
https://doi.org/10.1097/01.aoa.0000527016.07972.b8 [ DOI:10.1111/1471-0528.14306] 55. Ross MG, Gala R. Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. Am J Obstet Gynecol. 2002;187(1):1-9. [ DOI:10.1067/mob.2002.123204] [ PMID] 56. Goldaber KG, Gilstrap LC, 3rd, Leveno KJ, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol. 1991;78(6):1103-7. 57. Tuuli MG, Stout MJ, Shanks A, Odibo AO, Macones GA, Cahill AG. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol. 2014;124(4):756-61. [ DOI:10.1097/AOG.0000000000000466] [ PMID] [ ] 58. Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, et al. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp and Ther Med. 2021;21(1):1. [ DOI:10.3892/etm.2020.9513] [ PMID] [ ] 59. Allanson ER, Grobicki K, Pattinson RC, Dickinson JE. Attitudes towards the implementation of universal umbilical artery lactate analysis in a South African district hospital. BMC pregnancy and childbirth. 2016;16(1):166. [ DOI:10.1186/s12884-016-0968-y] [ PMID] [ ] 60. Racinet C, Richalet G, Corne C, Faure P, Peresse JF, Leverve X. [Diagnosis of neonatal metabolic acidosis by eucapnic pH determination]. Gynecologie, obstetrique & fertilite. 2013;41(9):485-92. [ DOI:10.1016/j.gyobfe.2013.07.020] [ PMID] 61. Mazouri A, Fallah R, Saboute M, Taherifard P, Dehghan M. The prognostic value of the level of lactate in umbilical cord blood in predicting complications of neonates with meconium aspiration syndrome. J Matern Fetal Neonatal Med. 2021;34(7):1013-9. [ DOI:10.1080/14767058.2019.1623195] [ PMID] 62. Tuuli MG, Stout MJ, Macones GA, Cahill AG. Umbilical cord venous lactate for predicting arterial lactic acidemia and neonatal morbidity at term. Obstet and Gynecol. 2016;127(4):674. [ DOI:10.1097/AOG.0000000000001339] [ PMID] [ ] 63. Kumar N, Yadav A. Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy. CEGH. 2020;8(3):927-33. [ DOI:10.1016/j.cegh.2020.02.026] 64. Patil SS, Rath S, George CE. Study on umbilical cord arterial blood gas analysis and cord blood lactate levels as predictors for adverse neonatal outcome: an observational study. IJRCOG 2018;7(4):1494-501. [ DOI:10.18203/2320-1770.ijrcog20181342] 65. Einikyte R, Snieckuviene V, Ramasauskaite D, Panaviene J, Paliulyte V, Opolskiene G, Kazenaite E. The comparison of umbilical cord arterial blood lactate and pH values for predicting short-term neonatal outcomes. Taiwanese J of Obstet and Gynecol. 2017;56(6):745-9. [ DOI:10.1016/j.tjog.2017.10.007] [ PMID] |
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Ethics code: IR.MUMS.MEDICAL.REC.1397.525
Ghomian N, Zandieh E, Zemorshidi M, Khadem-Rezaiyan M. The Relationship between the Lactate Level of Umbilical Cord Blood with Early Neonatal Complications. SJKU 2023; 28 (1) :87-97 URL: http://sjku.muk.ac.ir/article-1-7211-en.html
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