PERINATOLOGY • Vol 24 • No. 1 • May–Aug 2023 • 19 In this study, the cord blood lactate levels in neonates with Apgar scores ≤ 3 at 1 minute and ≤ 6 at 5 minutes were 7.8 (6.2–10.4) mmol/L and 10.2 (7.78–10.7) mmol/L, respectively. This shows that the neonates with low Apgar scores had high cord blood lactate levels; hence, the correlation between Apgar score and cord blood lactate level was highly significant (P = 0). The findings of this study suggest that cord blood lactate level can be used as an early predictor of neonatal mortality. Taheripanah et al6 report that a low Apgar score at 5 minutes is associated with high cord blood lactate level and recommend that umbilical cord blood lactate level may be considered as a useful predictor of fetal asphyxia at delivery. Van Anh et al7 report that the mean cord blood lactate level in asphyxiated neonates without hypoxic–ischemic encephalopathy (HIE) was 6.86 mmol/L and in neonates with HIE, it was 8.72 mmol/L. They conclude that umbilical cord blood lactate level can be used as an early predictor of HIE. In this study, the cord blood lactate level in neonates that cried at birth was 2.9 (2.11–3.60) mmol/L and in neonates that did not cry at birth, it was 6.26 (6.11– 10.34) mmol/L. This shows that cord blood lactate level was high in neonatal asphyxia. Haiju et al2 state that cord blood lactate level is a sensitive marker for evaluating neonatal mortality and HIE. Polackova et al’s8 study shows that excess lactate is associated with adverse outcomes in asphyxiated neonates. In this study, cord blood lactate levels in the gestational hypertension, preeclampsia, and eclampsia groups were 2 (1.8–3.3) mmol/L, 4 (2.4–5.8) mmol/L, and 2 (1.1–3.1) mmol/L, respectively. These findings show that cord blood lactate level was significantly affected by the severity of PIH. Cord blood lactate level was < 3 mmol/L in 27 (71%) neonates who were managed on room air, 3 to 8 mmol/L in 11 (31%) neonates on room air, and > 8 mmol/L (ie, 6.4 [5.0–9.5] mmol/L) in all the 5 (100%) neonates who needed ventilator support. Wiberg et al1 show that cord blood lactate level is as good as the pH of the cord blood sample in indicating a depressed neonate, at birth. They conclude that lactate is the best indicator of tissue hypoxia in the early neonatal period.1 In a study by Wing et al,9 it was seen that cord blood lactate level in neonates without evidence of fetal distress was 3.6 ± 1.4 mmol/L and in those with evidence of fetal distress, it was 4.7 ± 1.3 mmol/L. Haiju et al2 report that cord blood lactate levels > 4 mmol/L were associated with poor neonatal outcomes in their study. A study by Tuuli et al10 showed that venous cord blood lactate had high predictability for arterial acidemia and that comparative prediction of neonatal morbidity was biologically plausible. Studies have considered different cutoff levels of cord blood lactate ranging from 3.3 to 10 mmol/L for predicting adverse neonatal outcomes.10 According to Shah et al’s3 report, neonates are at a high risk of neurologic and other systemic complications when their lactate levels increase beyond 7.5 mmol/L. In this study, all 38 (100%) neonates with cord blood lactate level < 3 mmol/L and 30 (83%) neonates with cord blood lactate level of 3 to 8 mmol/L were alive. All 5 (100%) neonates with cord blood lactate level > 8 mmol/L (ie, 8 [5.8–10.2] mmol/L) died. In a study conducted by Shah et al,3 a cord blood lactate level > 15 mmol/L was considered to be predictive of death. Aiken et al11 report that cord blood lactate level > 10 mmol/L is indicative of a risk of adverse outcomes such as a high risk of disability. Cord blood lactate level > 15 to 20 mmol/L is predictive of death. Conclusions In developing countries such as India, neonatal mortality is a cause of significant concern. This may be because of illiteracy, lack of adequate maternal and child care facilities in rural areas, and attitudinal issues in the urban areas. Based on the findings of this study, a significant correlation exists between a high cord blood lactate level and a low Apgar score and the method of oxygen inhalation, which can result in neonatal mortality. Thus, we conclude that cord blood lactate level is useful in predicting neonatal mortality in PIH and recommend its inclusion as a vital parameter in assessing neonatal mortality. Acknowledgments The authors thank the patients who participated in this study, their caretakers, and the clinical and laboratory Research Article Kumar N, et al. Cord Blood Lactate Level and Neonatal Mortality in PIH
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