Zipf Stephanie, Fortmann Ingmar, Härtel Christoph, Andres Oliver, Frieauff Eric, Paul Pia, Häfke Anna, Reutter Heiko, Morhart Patrick, Weller Ursula, Welp Amrei, Kipke Henry, Herting Egbert, Humberg Alexander, Göpel Wolfgang, Hanke Kathrin
Department of Pediatrics, University of Würzburg, Würzburg, Germany.
Department of Pediatrics, University Hospital Schleswig-Holstein/ Campus Lübeck, Lübeck, Germany.
Front Pediatr. 2024 Oct 3;12:1443066. doi: 10.3389/fped.2024.1443066. eCollection 2024.
Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks.
We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22-28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models.
First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2-27.9] weeks and birth weight of 840 g [IQR 665-995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03-1.37; = 0.002) and BPD (OR 1.23; 95% CI 1.06-1.43; = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54-0.85; = 0.001).
In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.
血清乳酸水平被用作围产期窒息的生物标志物，但其对早产儿预后预测的价值尚不确定。本观察性研究的目的是确定出生后第1天的首次血清乳酸水平与孕周小于29周的早产儿短期预后之间的关联。
我们分析了德国新生儿网络（GNN）以人群为基础的队列研究中的数据，这些数据来自于2009年4月1日至2020年12月31日期间孕周为22 - 28周（GA）且有首次出生后乳酸水平数据的早产儿。我们假设，无论出生体重小于胎龄（SGA）状态如何，以mmol/L为单位测量的高乳酸水平会增加极低出生体重儿发生脑室内出血（IVH）和支气管肺发育不良（BPD）的风险。在单因素分析和多因素逻辑回归模型中对假设进行评估。
2499名婴儿有出生后首次乳酸水平数据。研究人群的中位孕周为26.7[四分位间距25.2 - 27.9]周，出生体重为840 g[四分位间距665 - 995]。发生IVH和BPD等短期并发症的婴儿初始乳酸水平高于未受影响的婴儿。乳酸水平临界值为4 mmol/L时，对IVH的阳性预测值为0.28，对BPD的阳性预测值为0.30。在对已知混杂变量进行调整后，出生后第1天乳酸水平每升高1 mmol/L，IVH风险适度增加（比值比1.18；95%置信区间1.03 - 1.37；P = 0.002），BPD风险也适度增加（比值比1.23；95%置信区间1.06 - 1.43；P = 0.005），但与败血症或死亡率无关。值得注意的是，SGA与任何级别的严重IVH风险较低相关（比值比0.70；95%置信区间0.54 - 0.85；P = 0.001）。
在我们的观察性队列研究中，无论SGA状态如何，较高的初始乳酸水平都与不良预后相关。然而，诸如4 mmol/L等乳酸临界值水平的预测价值较低。
