TO ASSESS RELATIONSHIPS BETWEEN LACTATE CLEARANCE AND BLOOD LACTATE LEVELS WITH OUTCOME OF NEONATAL SEPSIS

Authors

  • Shumaila chaudhry The children Hospital Lahore
  • Farah Haroon Associate Professor of Neonatology, The Children’s Hospital and Institute of Child Health, Lahore
  • Khawaja Ahmed Irfan Waheed Head of Department of Neonatology, The Children’s Hospital and Institute of Child Health, Lahore
  • Gideon Victor Shifa Tameer-e-Millat University
  • Muhammad Shahzad Assistant Professor, The Children’s Hospital and Institute of Child Health, Lahore
  • Bushra Fatima Assistant Professor, The Children’s Hospital and Institute of Child Health, Lahore

DOI:

https://doi.org/10.55519/JAMC-03-9087

Abstract

Background: Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection. Aim of the study is Neonatal sepsis refers to infection involving the blood stream in neonates. It is major health problem causing neonatal mortality and morbidity in developing countries. Our study aimed to assess the correlation between lactate clearance and blood lactate levels with outcome of neonatal sepsis. Methods: Seventy-three eligible neonates recruited with convenience sampling technique. Study was conducted at the Neonatology department, The Children’s Hospital & the Institute of Child Health, Lahore. After approval from institutional review board, and informed consent of parents/guardians, neonates with sepsis were selected through a present inclusion and exclusion criteria. Data was collected with the predetermined demographics, inflammatory markers and lactate levels. Results: This research revealed 37% (n=27) mortality rate among septic neonates who were having higher blood lactate levels and low lactate clearance at 6 hours of admission in nursery. Hence higher serum lactate levels and low lactate clearance (<10%) at 6 hours were significant predictors of poor outcome in septic neonates (p-Value, <0.05). The lactate level of neonates who could not survive was 5.68±1.22 as compared to who were discharged 4.11±1.14 (p-Value, <0.05). Conclusion: Higher blood lactate levels and lactate clearance of less than 10% at 6 hours of admission in nursery are significant predictors of mortality in neonatal sepsis. Early lactate stabilization and sepsis management can improve the clinical outcomes.

References

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801–10.

Berardi A, Rossi C, Lugli L, Creti R, Reggiani MLB, Lanari M, et al. Group B streptococcus late-onset disease: 2003–2010. Pediatrics 2013;131(2):e361–8.

Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017;390(10104):1770–80.

WHO. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization; 2019.

Amare D, Mela M, Dessie G. Unfinished agenda of the neonates in developing countries: magnitude of neonatal sepsis: systematic review and meta-analysis. Heliyon 2019;5(9):e02519.

Emr BM, Alcamo AM, Carcillo JA, Aneja RK, Mollen KP. Pediatric sepsis update: how are children different? Surg Infect (Larchmt) 2018;19(2):176–83.

Li-xing QI, Zuan-hao QI, Yi-nan ZH, Hai-lang LI, Xi-rong GU. Primary study on prognostic value of early arterial blood lactate clearance rate in the neonatal critical illness. Chin J Evid-Based Pediatr 2010;5(6):442–6.

Short MA. Linking the sepsis triad of inflammation, coagulation, and suppressed fibrinolysis to infants. Adv Neonatal Care 2004;4(5):258–73.

Wardi G, Brice J, Correia M, Liu D, Self M, Tainter C. Demystifying Lactate in the Emergency Department. Ann Emerg Med 2020;75(2):287–98.

Sun YS, Yu JL. Clinical value of blood lactate in predicting the prognosis of neonatal sepsis. Zhongguo Dang Dai Er Ke Za Zhi 2019;21(7):629–34.

Trisnadi FN, Haksari EL, Wibowo T. Lactate clearance as a predictor of mortality in neonatal sepsis. Paediatr Indones 2016;56(4):193–8.

Qian L, Yang L, Qiao L, Zheng Y, Jiang L. Clinical Value of Early Lactate Clearance Rate on Evaluation of Prognosis in Severe Asphyxia Neonate. J Appl Clin Pediatr 2011;26(6):427–9.

Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015;385(9966):430–40.

Saleem AF, Qamar FN, Shahzad H, Qadir M, Zaidi AKM. Trends in antibiotic susceptibility and incidence of late-onset Klebsiella pneumoniae neonatal sepsis over a six-year period in a neonatal intensive care unit in Karachi, Pakistan. Int J Infect Dis 2013;17(11):e961–5.

Wei HM, Hsu YL, Lin HC, Hsieh TH, Yen TY, Lin HC, et al. Multidrug-resistant Acinetobacter baumannii infection among neonates in a neonatal intensive care unit at a medical center in central Taiwan. J Microbiol Immunol Infect 2015;48(5):531–9.

Hamid NF, Elkhider ME, Ebrahim NMTA, Saud A, Alyasi M, Rizk MMM. Neonatal sepsis in association with birth weight, gestational age, and mode of delivery in Saudi Arabia: A systematic review and meta-analysis. Med Sci 2021;25(111):1071–9.

Chen D, Liu X, Li J. Lactate levels and clearance rate in neonates undergoing mechanical ventilation in Tibet. J Int Med Res 2020;48(10):0300060520962388.

Ryoo SM, Lee J, Lee YS, Lee JH, Lim KS, Huh JW, et al. Lactate Level Versus Lactate Clearance for Predicting Mortality in Patients With Septic Shock Defined by Sepsis-3. Crit Care Med 2018;46(6):e489–95.

Iskandar A, Pranidya NP, Sulistijono E, Aryati A. Correlation Between Lactic Acid Concentration and The Severity of Neonatal Sepsis. Indones J Clin Pathol Med Lab 2019;26(1):55–9.

Aramburo A, Todd J, George EC, Kiguli S, Olupot-Olupot P, Opoka RO, et al. Lactate clearance as a prognostic marker of mortality in severely ill febrile children in East Africa. BMC Med 2018;16(1):37.

Published

2022-06-21

Most read articles by the same author(s)