title: Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review.
abstract: BACKGROUND
  Umbilical cord lactate is one approach to measuring acidosis and intrapartum hypoxia, knowledge of which may be helpful for clinicians involved in the care of women and newborns.
  
  
  OBJECTIVE
  To synthesise the evidence on accuracy of umbilical cord lactate in measuring acidosis and predicting poor neonatal outcome.
  
  
  METHODS
  Studies published and unpublished between 1990 and 2014 from PubMed/Medline, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were assessed.
  
  
  METHODS
  Cross-sectional and randomised studies that assessed fetal acidosis (using lactate as the index test) with or without an assessment of neonatal outcome.
  
  
  METHODS
  Correlations between index and reference test(s) were recorded, as were the raw data to classify the predictive ability of umbilical lactate for neonatal outcomes. Meta-analysis of correlation was performed. We plotted estimates of the studies' observed sensitivities and specificities on Forest plots with 95% confidence intervals (CI). Where possible, we combined data using meta-analysis, applying the hierarchical summary receiver operating characteristics model and a bivariate model.
  
  
  RESULTS
  Twelve studies were included. Umbilical lactate correlated with pH [pooled effect size (ES) -0.650; 95% CI -0.663 to -0.637, P < 0.001], base excess (ES -0.710; 95% CI -0.721 to -0.699, P < 0.001), and Apgar scores at 5 minutes (ES 0.300; 95% 0.193-0.407, P < 0.001). Umbilical lactate had pooled sensitivity and specificity for predicting neonatal neurological outcome including hypoxic ischaemic encephalopathy of 69.7% (95% CI 23.8-94.4%) and 93% (95% CI 86.8-96.3%).
  
  
  CONCLUSIONS
  Umbilical cord lactate is a clinically applicable, inexpensive and effective way to measure acidosis and is a tool that may be used in the assessment of neonatal outcome.
  
  
  CONCLUSIONS
  Umbilical cord lactate: a clinically applicable, inexpensive, effective way to measure intrapartum acidosis.
authors.affiliation: School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia.|Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: E R
authors.initials: ER
authors.lastname: Allanson
authors.affiliation: CMH Medical College, CMH Lahore, Lahore, Pakistan.
authors.forename: T
authors.initials: T
authors.lastname: Waqar
authors.affiliation: School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia.
authors.forename: Crh
authors.initials: C
authors.lastname: White
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Dickinson
mesh_terms: D000138:Acidosis / Q000175:diagnosis*; D001034:Apgar Score; D005260:Female; D005312:Fetal Blood / Q000378:metabolism*; D005316:Fetal Distress / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood*; D011247:Pregnancy; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity
chemical_list: D019344:Lactic Acid
keywords: Acidosis; intrapartum; lactate; neonatal risk