Abstract
Objectives: To determine the utility of umbilical venous lactate measurements for predicting poor neonatal outcomes.
Method: This observational study was conducted at Kahuta Research Laboratories (KRL) hospital, Islamabad from May 2019 to October 2019. Singleton pregnancies with no known fetal congenital anomalies and gestational age greater than 28 weeks were included. Descriptive statistics were used to analyse the characteristics of study subjects and also composite neonatal outcomes. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.
Result: Umbilical venous lactate levels were found to be highest in instrumental deliveries (48.7%) and lowest in those delivered by elective cesarean section (25.7%). Low APGAR score, need for initial resuscitation & neonatal intensive care unit admission, mechanical ventilation and neonatal morbidity were all associated with significantly higher lactate levels. Based on the maximal yield index, the optimal cut-off point for predicting neonatal morbidity was 46.5mg/dl (area under the receiver operating characteristics curve was 0.8). Based on this optimal cut-off point, it has a sensitivity of 62%, specificity of 92%, PPV 51% and NPV 94% for neonatal morbidity.
Conclusion: Umbilical venous lactate measurement is a good predictor of poor neonatal outcome especially in situations when umbilical arterial blood cannot be taken due to technical difficulty. Mode of delivery has a strong association with fetal hypoxia and raised umbilical lactate levels.
Keywords: lactate, neonatal outcomes, labour ward.
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