1. The Association between Hyperlactatemia and Adverse Long Term Outcome in Infants with Moderate to Severe Hypoxic Ischemic Encephalopathy 1Mohamed S. Elboraee, 1,2Ernest Phillipos, 4Leonora Hendson, 1,2,3,6Amber Reichert, 5Xiang Y. Ye, 1,3,6Mosarrat Qureshi
1University of Alberta, Edmonton AB; 2Stollery Children’s Hospital, Edmonton AB; 3Royal Alexandra Hospital, Edmonton AB; 4University of Calgary, Calgary AB; 5MiCare research Center, Toronto ON, 6Glenrose Rehabilitation Hospital, Edmonton AB
Background
Results
Tables
Of 167 infants, 106 had initial lactate >5.0mmol/L (63%) and 48 had initial lactate <5.0mmol/L (29%). Data was missing on 13 infants (8%) (Fig 1) . Thirty two out of the 167 infants (19%) died (Fig 2).
After adjustment, initial Lactate was significantly associated with the primary outcome (OR: 1.06; 95%CI: ). In addition, the time required for lactate to normalize (≤2.0mmol/l) was associated with the primary outcome [table1].
The ROC curve (Fig 3) showed that initial Lactate>16mmol/L is significant (P0.0015) for detection of adverse outcome; sensitivity 29.3% and specificity 90.5% [table2].
Hypoxic ischemic encephalopathy (HIE) remains one of the most devastating events in the newborn period.
Lactate is invariably produced with hypoxia and poor tissue perfusion.
Initial highest lactate in the first hour of life and serial measurements of blood lactate have been found to be important predictors of moderate to severe neonatal encephalopathy in cases of intrapartum asphyxia.
Table(1) Association between patient characteristics & outcome in infants with HIE II/III
No Death or Disability
Death or any Disability
p-value
Gender (male), %(n/N)
65.35 (66/101)
44.62 (29/65)
0.008
Apgar score<5 at 5 min, %(n/N)
60.42 (58/96)
87.3 (55/63)
0.0003
Initial pH <7.0 %(n/N)
22.35 (19/85)
54.39 (31/57)
<0.0001
Initial Lactate, mean(sd)
8.5 (5.6)
11.7 (7.2)
0.005
Highest Lactate, mean(sd)
9.5 (5.6)
14.2 (8.3)
0.0002
Normalization of Lactate, %(n/N)
0.001
<24hrs
29.27 (24/82)
6.98 (3/43)
24-48hrs
36.59 (30/82)
27.91 (12/43)
>48hrs
34.15 (28/82)
65.12 (28/43)
Objectives
Figures
To examine the association between initial lactate level and the long term adverse outcome in infants with moderate to severe HIE (HIE II/III).
We hypothesized that the level of hyperlactatemia and time required for it to normalize in HIE infants can predict long term adverse neurodevelopmental outcome.
Table(2) Association between Initial Lactate level and the adverse outcome in infants with moderate or severe HIE
No Death or Disability
Death or any Disability
p-value
Infants number
101 65
Initial Lactate >16, %(n/N)
9.5 (9/95)
29.3 (17/58)
0.0015
Methods
A retrospective chart and database review for all infants
≥ 35 weeks gestational age treated in the Northern Alberta Neonatal Program with HIE II/III from January 2006 to December 2012 (excluding infants who were growth restricted or with major congenital anomalies).
The primary outcome was composite of death or any disability (cerebral palsy, cognitive delay <2SD below the mean, hearing loss and blindness) at 18 months or 3 years of age.
Univariate and multivariable regression analyses were used to compare the outcome.
Fig 1. Study Population
Fig 2. The Outcome of HIE infants
Conclusions
Most term or near term infants with HIE II/III had initial lactate > 5 mmol/L
Initial Lactate >16 mmol/L was associated with the adverse outcome
The longer it takes for the lactate to normalize, the poorer the outcome (Fig 4)
This research has been funded by the WCHRI through the generous support of the Stollery Children's Hospital Foundation
Fig 4. ROC curve for the Initial Lactate