16 • PERINATOLOGY Vol 24 • No. 1 • May–Aug 2023 Key Words: Asphyxia, lactic acidosis, hypoxia, Apgar score, gestational age, preeclampsia, eclampsia, continuous positive airway pressure, ventilator, room air, nasal prongs Introduction Several maternal and fetal factors determine neonatal outcomes. Pregnancy-induced hypertension (PIH) is the second most common condition seen during pregnancy. PIH poses as a risk factor of birth asphyxia at antepartum. Upon prolonged fetal exposure to hypoxia, anaerobic metabolism sets in. When the oxygen level is critically low, aerobic metabolism cannot ensue, and tissues resort to anaerobic metabolism for their energy needs. This leads to the accumulation of lactate in the tissues, which is the end product of anaerobic metabolism, and results in lactic acidosis.1-3 The secondary phase starts after a latent period of at least 6 hours and is characterized by reperfusion, cytotoxic edema, mitochondrial failure, accumulation of excitotoxins, cell death, nitric oxide synthesis, free radical damage, and cytotoxic actions of activated microglia. Encephalopathy and increased seizure activity are seen in this phase.4 The lactate in the umbilical cord blood is said to be mostly of fetal origin.5 Also, collecting the blood sample from the umbilical vein is easy because of its large lumen. Hence, a measure of the umbilical cord blood lactate level would be useful to detect tissue hypoxia, assess illness severity, and thus, determine the prognosis. Aim To assess the role of umbilical venous lactate level in the early prediction of neonatal mortality in women with PIH Materials and Methods Study design This was an observational study conducted at Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSR; Amritsar, Punjab, India) between February 1, 2019, and July 31, 2020. A total of 80 pregnant women with PIH were enrolled into the study to observe the neonatal outcomes. Approval for the study was sought from the institutional ethics committee, and informed consent was sought from the parents of the neonates. Inclusion criteria All neonates born to women with PIH, delivered either through vaginal or cesarean delivery during the study period were included. Exclusion criteria • Neonates with multiple congenital anomalies (neuromuscular, cardiac, and pulmonary disorders) • Neonates referred from other hospitals in and around Amritsar district • Neonates with intrauterine infections and sepsis Study procedure Birth asphyxia was determined based on the Apgar scores at 1 and 5 minutes. To measure the cord blood lactate level, a pre-heparinized syringe was used to draw 2 mL of cord blood from all the neonates. The serum lactate level was determined using RAPIDLab® blood gas analyzer (Siemens Healthineers, Erlangen, Germany). Statistical analyses Statistical analyses were performed using SPSS version 26 for Windows (IBM Corp, Armonk, NY, USA). Student’s t test was used to determine the statistical significance of the variables analyzed. A P value < .05 was considered statistically significant. As the data were collected through random samples during the stipulated period, the nonparametric test Research Article Kumar N, et al. Cord Blood Lactate Level and Neonatal Mortality in PIH
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