Objective To explore the value of arterial blood lactate and lactate clearance in early evaluation of brain injury in asphyxia neonates, in order to provide reference for the early identification of brain injury in neonates. Methods A total of 129 cases of neonatal asphyxia admitted to Neonatology Department, Longgang District Central Hospital of Shenzhen from May 2016 to May 2019 were retrospectively analyzed.According to whether the children had neurological symptoms or abnormal amplitude integrated electroencephalogram monitoring results, the neonates were divided into brain injury group (n=83 cases) and non-brain injury group (n=46).The differences in arterial blood pH, base excess (BE), lactate and lactate clearance between the two groups were analyzed.The rates of brain injury, poor prognosis and fatality of children were compared between children with high and low lactic acid level and lactate clearance.Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of arterial blood lactic acid and lactate clearance in brain injury of asphyxia neonates. Results There were 9 deaths brain injury group, 26 with poor prognosis and 48 with good prognosis among survivors.The pH and BE of arterial blood in the brain injury group were significantly lower than those in non-brain injury group within 1 hour after birth, while the lactic acid level was significantly higher than that in the non-brain injury group (t=10.159, 9.023, 9.917, P<0.01).The pH of arterial blood and the lactate clearance of lactic acid in the brain injury group were lower than those in the non-brain injury group at 6 hours after treatment, while the lactic acid level was higher than that in the non-brain injury group (t=4.869, 9.708, 9.917, P<0.05).There was no statistically significant difference in the BE value within 6 hours after treatment (t=1.732, P>0.05).The brain damage rate, poor prognosis rate and fatality rate of children in the high lactic acid group were significantly higher than those in the low lactic acid group(χ2=54.692, 11.790, 5.926, P<0.05), which were also significantly higher in high lactate clearance group than those in low lactate clearance group(χ2=71.816, 15.016, 6.966, P<0.05).ROC curve analysis showed that joint monitoring of arterial blood lactic acid and lactate clearance predicted brain injury ability best, with sensitivity of 100% and specificity of 98.6%. Conclusion The joint monitoring of arterial blood lactic acid and lactate clearance has certain clinical value in early screening of brain injury and prognosis judgment in asphyxia neonates.
Key words
lactic acid /
lactate clearance /
asphyxia /
brain injury /
neonate
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