First postnatal lactate blood levels on day 1 and outcome of preterm infants with gestational age <29 weeks.

IF 2.1 3区医学 Q2 PEDIATRICS

Frontiers in Pediatrics Pub Date : 2024-10-03 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1443066

Stephanie Zipf, Ingmar Fortmann, Christoph Härtel, Oliver Andres, Eric Frieauff, Pia Paul, Anna Häfke, Heiko Reutter, Patrick Morhart, Ursula Weller, Amrei Welp, Henry Kipke, Egbert Herting, Alexander Humberg, Wolfgang Göpel, Kathrin Hanke

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Abstract

Background: Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks.

Methods: We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22-28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models.

Results: First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2-27.9] weeks and birth weight of 840 g [IQR 665-995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03-1.37; p = 0.002) and BPD (OR 1.23; 95% CI 1.06-1.43; p = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54-0.85; p = 0.001).

Conclusions: In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.

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胎龄小于 29 周的早产儿出生后第 1 天的首次乳酸血浓度与预后。

背景：血清乳酸水平被用作围产期窒息的生物标志物，但其对早产儿预后的价值尚不确定。本观察性研究旨在确定出生后第 1 天血清乳酸水平与妊娠周数小于 29 周的早产儿短期预后的关系：我们分析了德国新生儿网络（GNN）早产儿人群队列中的数据，这些早产儿在 2009 年 4 月 1 日至 2020 年 12 月 31 日期间的胎龄（GA）为 22-28 周，出生后首次乳酸水平可用。我们假设，以 mmol/L 为单位的高乳酸水平会增加 VLBW 婴儿发生脑室内出血（IVH）和支气管肺发育不良（BPD）的风险，而与小胎龄（SGA）状态无关。通过单变量分析和多元逻辑回归模型对假设进行了评估：结果：2499 名婴儿获得了产后首次乳酸水平。研究对象的中位孕期为 26.7 [IQR 25.2-27.9]周，出生体重为 840 克 [IQR 665-995]。与未受影响的婴儿相比，患有 IVH 和 BPD 等短期并发症的婴儿的初始乳酸水平较高。乳酸临界值为 4 mmol/L 时，对 IVH 的阳性预测值为 0.28，对 BPD 的阳性预测值为 0.30。在对已知混杂变量进行调整后，第 1 天乳酸水平每增加 1 mmol/L 与 IVH（OR 1.18；95% CI 1.03-1.37；p = 0.002）和 BPD（OR 1.23；95% CI 1.06-1.43；p = 0.005）风险的适度增加有关，但与败血症或死亡率无关。值得注意的是，SGA 与任何等级和严重 IVH 的较低风险相关（OR 0.70；95% CI 0.54-0.85；p = 0.001）：结论：在我们的观察性队列研究中，无论是否为SGA，初始乳酸水平越高与不良预后越相关。结论：在我们的观察性队列研究中，无论 SGA 状况如何，较高的初始乳酸水平与不良预后相关。然而，乳酸临界水平（如 4 mmol/L）的预测价值较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health

CiteScore

3.60

自引率

7.70%

发文量

2132

审稿时长

14 weeks

期刊介绍： Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.