Blood lactate

[manberbenitez]

Dear 99Nicu friends:
In this thread I want to know your opinion about:
1.- Which is the real validity of result of lactate in blood gases.
2.- Does the lactate in the neonatal period is really a predictor of good or bad prognosis(neurologic)
3.- Can you tell which decision you make whne you have a blood gas lactate value high.
4.- Which is the value of blood gas lactate that really worry.

This questions are because in my unit there is a tendency of give a saline bolus at 10-15 ml/Kg in all the babies that have little, moderate or high lactate value. I understand that if there a severe organic disfunction is logically that the lactate value it will be high, but there ar others causes of high lactate that no require saline bolus.
thanks in advance, and if you haVE SOME articles I will appreciate.
Your friend. Manuel

[Stefan Johansson]

Dear Manuel,
I do not have real knowledge about this and would appreciate responses from other members too. We also get s-lactate levels on our new blood gas machine but we do not consider the values so much.
Naturally, in investigations for metabolic diseases, we generally check lactate in blood and liqour.
But I guess your question is more related to whether lactate reflects poor peripheral perfusion (indicated by your protocol for giving saline bolus if lactate increase).

Will do some PubMed search later since this question also interests me, just need some recovery from my night shift!

[mbayari]

Hi dear
Ourexperience is that the interpretation of lactate level alone can not be so helpful; you should into account PH value, PcO2...The AAP/ ACOG committees on maternal-fetan medicine in 1993 have clearly defined the birth asphyxia criteria. Searches are still ongoing to find a "marker" of bad outcome and blood lactate seems not to be one them; some authors have proposed the evaluation of urinary lactate/ creatinine ratio as a marker of outcome. Recent advances in this field are focusing on neuroimaging prognostic markers (Apparent Diffusion Coefficient, Diffusion Tensor Imaging and MRS: lactate/coline in basalganglia and white matter;NAA/ choline...). SNAP-PE is well correlated to 30 months outcome in a population of term birth asphyxia.

[ammar]

Hi

we use commonly lactate with other parametres and not alone to identify signs and risks for:
* septic risk (early or late onset sepsis)
* circulatory insuffisancy
* ischemic-hypoxemic encephalopathia of the term newborn
* response to ressucitation
the cinetic of values is very important but i can't say to you which valus is the define marker.