The utility of cord blood lactate as a low-resource tool in perinatal asphyxia diagnosis and prognosis; lessons from a tertiary hospital in Southern Nigeria.

Abstract

Perinatal asphyxia (PA) is a global health concern associated with long-term morbidity and significant mortality. Limited finance and inadequate facilities are the bane of the low- and middle-income countries (LMICs) making the diagnosis of PA challenging. The identification of cheap, simple, specific, and sensitive, biochemical parameter as an alternative to blood gas analysis would improve the assessment of PA in LMICs. This study is designed to assess the utility of umbilical cord arterial blood (UCAB) lactate in diagnosis and prognosis of PA among term babies. This was a prospective, cross-sectional analytical study done at UBTH over a 7-month period. The inclusion criteria for PA were documented risk factors, Apearance, Pulse, Grimace, Activity, Respiration (APGAR) score of <7 in 5 minutes, and umbilical cord pH ≤7.25. Samples were collected from the umbilical cord segments of 132 study participants and analysed using Abbott i-STAT. Sixty-six asphyxiated babies were the subjects for this study. The median (interquartile range) UCAB lactate value of the asphyxiated newborns was 7.23 (5.90-9.41) mmol/l which is significantly higher than the apparently healthy newborns of 2.97 (2.27-3.82) mmol/l (U = 4175.50; P < .001). The optimal diagnostic cut-off value of UCAB lactate in the diagnosis of PA was >5.1 mmol/l, with a sensitivity of 89.4% and specificity of 90.9%. The optimal cut-off value of UCAB lactate in predicting short-term adverse neonatal outcome (moderate to severe encephalopathy) was >8.32 mmol/l, having a sensitivity of 100% and specificity of 94.7%. UCAB lactate shows a good performance in the diagnosis of PA and prediction of short-term outcome among term neonates.