title: Serum lactate levels and perfusion index: are these prognostic factors on mortality and morbidity in very low-birth weight infants?
abstract: OBJECTIVE
  Early hemodynamic assessment of global parameters in critically ill newborns fails and requires mostly invasive measurements in neonatal intensive care unit. Clinical signs are frequently used for assessment of peripheral perfusion. Perfusion index (PI) is a new noninvasive numerical value of peripheral perfusion. Serum lactate levels and PI are the indicators that are important in determining prognosis of preterm infants. In this study, we aimed to investigate the relationship of serum lactate levels and PI with mortality and morbidity in very low-birth weight infants (VLBW).
  
  
  METHODS
  This study was conducted between July 2014 and July 2015 in a Level III NICU. The study enrolled preterm infants with a gestational age ≤ 32 weeks, birth weight ≤ 1500 g. Serum lactate levels from blood gases and PI, SpO2 measurements were recorded at 1st, 12th and 24th hours by using a new generation pulse-oximeter. Morbidities and mortalities were documented.
  
  
  RESULTS
  A total of 60 VLBW infants were enrolled the study. Mean birth weight and gestational age were 991 ± 288 g and 27.5 ± 2.5 w, respectively. Retinopathy of prematurity (ROP) was significantly higher in the patients with high lactate levels (>4 mg/dl) at 1st hour and low-PI levels (<0.5) at 12th hour of life (p = 0.042, p = 0.015), respectively. Bronchopulmonary displasia (BPD) was significantly higher in the patients with low PI (< 0.5) at 1st hour. Lactate and PI values were not significantly correlated with necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, sepsis and mortality.
  
  
  CONCLUSIONS
  High lactate levels (> 4 mg/dl) and low PI (< 0.5) could be used as early parameters for prediction of ROP and BPD. This data suggests that in VLBW infants lactate levels and PI parameters during the first 24 h will be effective in determining the prognosis of the disease. We believe that larger, randomized controlled clinical trials are likely to establish the true benefit.
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Abdulhamit
authors.initials: A
authors.lastname: Tuten
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Emre
authors.initials: E
authors.lastname: Dincer
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Sevilay
authors.initials: S
authors.lastname: Topcuoglu
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Selim
authors.initials: S
authors.lastname: Sancak
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Selahattin
authors.initials: S
authors.lastname: Akar
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Handan
authors.initials: H
authors.lastname: Hakyemez Toptan
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Elif
authors.initials: E
authors.lastname: Özalkaya
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Tulin
authors.initials: T
authors.lastname: Gokmen
authors.affiliation: b Neonatology, Istanbul Medeniyet Universitesi , Istanbul , Turkey.
authors.forename: Fahri
authors.initials: F
authors.lastname: Ovalı
authors.affiliation: a Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Guner
authors.initials: G
authors.lastname: Karatekin
mesh_terms: D015415:Biomarkers / Q000097:blood; D020345:Enterocolitis, Necrotizing / Q000097:blood* / Q000401:mortality; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D007363:Intensive Care Units, Neonatal; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000097:blood* / Q000401:mortality; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: Lactate; ROP; VLBW; perfusion index; prematurity