Department of Pediatrics, Faculty of Medicine, Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of Pediatrics, Faculty of Medicine, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
J Matern Fetal Neonatal Med. 2021 Apr;34(7):1013-1019. doi: 10.1080/14767058.2019.1623195. Epub 2019 Jul 24.
In spite of significant advances in therapeutic, diagnostic and even medical modalities, meconium management continues to be a concern for management. It has been recently assumed that trace of lactate in both serum and urine can be a sign of the asphyxia in neonates. However, no study has been done on the prognostic value of increasing lactate concentration in umbilical cord blood for predicting the outcomes of meconium aspiration syndrome (MAS), which was our aim in this study.
Thin cross-sectional study was performed on 150 neonates suffering meconium aspiration syndrome who were admitted to Akbar Abadi hospital in Tehran between 2016 and 2018. Samples of umbilical cord blood were extracted from neonates and sent to the reference laboratory to measure lactate level as well as arterial blood gas analysis. The neonatal characteristics as well as postdelivery complications were also collected by reviewing the hospital recorded files.
Thick meconium stained amniotic fluid (TKMSF) was found in 40.0% and thin meconium stained amniotic fluid (TNMSF) in 60.0%. The mean level of lactate was significantly higher in those neonates with morbidities including pulmonary hemorrhage, persistent pulmonary hypertension of the neonate (PPHN), intraventricular hemorrhage (IVH), and respiratory failure requiring ventilation support. According to the ROC curve analysis, increasing lactate in umbilical cord blood could predict occurrence of pulmonary hemorrhage (AUC = 0.885), PPHN (AUC = 0.832), IVH (AUC = 0.898), and requiring ventilation (AUC = 0.833). Comparing the two groups with TKMSF and TNMSF showed higher gestational age, lower Apgar score, lower BE, higher PCO, lower PO, lower PH as well as higher serum lactate. In this regard and using the ROC curve analysis (Table 4), increased lactate could effectively discriminate TKMSF from TNMSF (AUC = 0.998) with the best cut-off value of 4.10.
The increase in lactate in the umbilical cord blood (>4.1 mmol/L with high sensitivity and specificity) can distinguish between thick meconium and thin meconium forms in amniotic acid and thus can determine the severity of MAS. Also, increasing serum lactate levels is an accurate indicator for predicting complications such as pulmonary hemorrhage, PPHN, IVH, and need for ventilation in newborns with this syndrome. This diagnostic accuracy is even beyond the usual markers for arterial gas analysis, such as PH, PCO, PO and BE.
尽管在治疗、诊断甚至医疗方式方面取得了重大进展，但胎粪管理仍然是一个令人关注的问题。最近有人认为，血清和尿液中的乳酸微量可以作为新生儿窒息的标志。然而，目前还没有研究表明脐带血中乳酸浓度的升高对预测胎粪吸入综合征（MAS）结局的预后价值，这正是我们在这项研究中的目的。
对 2016 年至 2018 年期间在德黑兰阿巴迪医院就诊的 150 例胎粪吸入综合征新生儿进行了横断面研究。从新生儿中提取脐带血样本，并送往参考实验室测量乳酸水平和动脉血气分析。通过查阅医院记录文件，收集新生儿特征和分娩后并发症。
胎粪染色羊水厚（TKMSF）发现 40.0%，胎粪染色羊水薄（TNMSF）发现 60.0%。在有肺出血、新生儿持续性肺动脉高压（PPHN）、脑室内出血（IVH）和需要通气支持的呼吸衰竭等并发症的新生儿中，乳酸的平均水平显著升高。根据 ROC 曲线分析，脐带血中乳酸的增加可预测肺出血（AUC=0.885）、PPHN（AUC=0.832）、IVH（AUC=0.898）和需要通气（AUC=0.833）的发生。比较 TKMSF 和 TNMSF 两组，胎龄较高，Apgar 评分较低，BE 较低，PCO 较高，PO 较低，PH 较低，血清乳酸较高。在这方面，使用 ROC 曲线分析（表 4），增加的乳酸能有效地将 TKMSF 与 TNMSF 区分开来（AUC=0.998），最佳截断值为 4.10。
脐带血中乳酸的增加（>4.1mmol/L，具有较高的敏感性和特异性）可以区分羊水厚胎粪和薄胎粪形式，从而可以确定 MAS 的严重程度。此外，血清乳酸水平的升高是预测新生儿肺出血、PPHN、IVH 和需要通气等并发症的准确指标。这种诊断准确性甚至超过了动脉血气分析的常用标志物，如 PH、PCO、PO 和 BE。
