The Association between Hyperlactatemia and Adverse Long Term Outcome in Infants with Moderate to Severe Hypoxic Ischemic Encephalopathy
CPS ePoster Library. Elboraee M. 06/22/16; 128182; 112
Dr. Mohamed Elboraee
Dr. Mohamed Elboraee
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Abstract
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Background: Hypoxic ischemic encephalopathy (HIE) remains one of the most devastating events in the newborn period. Lactate is invariably produced with hypoxia and poor tissue perfusion. Initial highest lactate in the first hour of life and serial measurements of blood lactate have been found to be important predictors of moderate to severe neonatal encephalopathy in cases of intrapartum asphyxia.

Objectives: To examine the association between initial lactate level and the long term adverse outcome in infants with moderate to severe HIE (HIE II/III). We hypothesized that the level and duration to normalize hyperlactatemia in HIE infants can predict long term adverse neurodevelopmental outcome.

Methods: A retrospective chart and database review for all infants ≥ 35 weeks gestational age treated in the Northern Alberta Neonatal Program with HIE II/III from January 2006 to December 2012 (excluding infants who were growth restricted or with major congenital anomalies). The primary outcome was composite of death or any disability (cerebral palsy, cognitive delay <2SD below the mean, hearing loss and blindness) at 18 months or 3 years of age. Univariate and multivariable regression analyses were used to compare the outcome.

Result: Of 167 infants, 106 had initial lactate >5.0mmol/L (63%) and 48 had initial lactate 16mmol/L is significant (P0.0015) for detection of adverse outcome; sensitivity 29.3% and specificity 90.5%.

Conclusion: Most term/near term infants with HIE II/III had initial lactate > 5mmol/L. Initial lactate >16 mmol/L and duration to normalization of lactate levels was associated with the adverse outcome.

Background: Hypoxic ischemic encephalopathy (HIE) remains one of the most devastating events in the newborn period. Lactate is invariably produced with hypoxia and poor tissue perfusion. Initial highest lactate in the first hour of life and serial measurements of blood lactate have been found to be important predictors of moderate to severe neonatal encephalopathy in cases of intrapartum asphyxia.

Objectives: To examine the association between initial lactate level and the long term adverse outcome in infants with moderate to severe HIE (HIE II/III). We hypothesized that the level and duration to normalize hyperlactatemia in HIE infants can predict long term adverse neurodevelopmental outcome.

Methods: A retrospective chart and database review for all infants ≥ 35 weeks gestational age treated in the Northern Alberta Neonatal Program with HIE II/III from January 2006 to December 2012 (excluding infants who were growth restricted or with major congenital anomalies). The primary outcome was composite of death or any disability (cerebral palsy, cognitive delay <2SD below the mean, hearing loss and blindness) at 18 months or 3 years of age. Univariate and multivariable regression analyses were used to compare the outcome.

Result: Of 167 infants, 106 had initial lactate >5.0mmol/L (63%) and 48 had initial lactate 16mmol/L is significant (P0.0015) for detection of adverse outcome; sensitivity 29.3% and specificity 90.5%.

Conclusion: Most term/near term infants with HIE II/III had initial lactate > 5mmol/L. Initial lactate >16 mmol/L and duration to normalization of lactate levels was associated with the adverse outcome.

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