Background and Aims
The assessment of hemodynamic status of the preterm neonates remains a challenge. Although blood pressure is still used as a parameter of the circulatory failure, neither an appropriate threshold value nor better outcomes after treating hypotension were found. Methods of diagnostic measures have been investigated, such as functional echocardiography, serum lactate, base excess, capillary refill time and superior cava vein flow.
Aims: To assess the sensitivity and specificity of lactate in the first 48 hours of life in relation to need of inotropic drugs and death before 10 days.Method
Retrospective cohort. Newborns (255) ≤1500g (2016 and 2017). Exclusion: malformations and death in the delivery room (39). 216 newborns were included. We tried to discriminate through a ROC curve the sensitivity and specificity lactate in the first 24 and 48 hours the newborn that developed adverse outcomes from those that did not (R software version 3.4.2.).
We didn’t found value with good specificity and sensitivity for death [24h-AUC=0,72(0,50;0,82);48h AUC=0,75(0,6;0,86)] and use of inotropes[24h-AUC=0,67(0,58;0,76);48h AUC=0,66(0,55;0,75)] . The sensitivity for lactate in the first 24 hours below 3mmol/l was 84% and specificity was 34% for death within 10 days of life;for inotropes, sensibility 79% and specificity 34%. Good specificity (80%) for death was 7,0 (24h) and 3,9 (48h), and inotropes 6,1 and 4,0, respectively.
Lactate is not a good clinical parameter for diagnosis of death or use of inotropes in preterm infants in the first 48 hours of life. No single biochemical parameter was found to be a good marker for preterm shock.