Association between urinary lactate to creatinine ratio and neurodevelopmental outcome in term infants with hypoxic-ischemic encephalopathy.
OBJECTIVE
To assess the association between urinary lactate to creatinine ratio (ULCR) and neurodevelopmental outcome in term infants with hypoxic ischemic encephalopathy and examine the effect of hypothermia on the change in ULCR.


METHODS
Spot urine samples were collected in 58 term infants (28 hypothermia, 30 control subjects) with hypoxic ischemic encephalopathy. Urinary lactate and creatinine were measured by using (1)H nuclear magnetic resonance spectroscopy and expressed as ULCR. Survivors were examined at 18 months of age.


RESULTS
The ULCR was significantly higher in infants who died or had moderate/severe neurodevelopmental disability. Logistic regression analysis controlling for hypothermia and severity of encephalopathy confirmed the association (adjusted odds ratio, 5.52; 95% CI, 1.36, 22.42; P < .02). Considerable overlap in ULCR was observed between infants with normal/mild disability and those who died or survived with moderate/severe disability. ULCR fell significantly between 6 and 24 hours and 48 and 72 hours of age for all infants. The magnitude of decline did not differ between hypothermia and control groups.


CONCLUSIONS
High ULCR is associated with death or moderate/severe neurodevelopmental disability. Significant overlap in values between the normal/mild and moderate/severe disability groups limits predictive value of this measure. Whole-body hypothermia did not affect the decline in ULCR.
Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.
William
W
Oh
Rebecca
R
Perritt
Seetha
S
Shankaran
Matthew
M
Merritts
Edward F
EF
Donovan
Richard A
RA
Ehrenkranz
T Michael
TM
O'Shea
Jon E
JE
Tyson
Abbot R
AR
Laptook
Abhik
A
Das
Rosemary D
RD
Higgins
D000328:Adult; D015415:Biomarkers / Q000652:urine; D002657:Child Development / Q000502:physiology*; D003404:Creatinine / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000503:physiopathology / Q000628:therapy / Q000652:urine*; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000652:urine*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors
D015415:Biomarkers; D019344:Lactic Acid; D003404:Creatinine