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AJP Rep 2016; 06(01): e48-e58
DOI: 10.1055/s-0035-1565921
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Secondary Increase of Lactate Levels in Asphyxiated Newborns during Hypothermia Treatment: Reflect of Suboptimal Hemodynamics (A Case Series and Review of the Literature)

Asim Al Balushi
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Marie-Pier Guilbault
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Pia Wintermark
2   Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
› Author Affiliations
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Publication History

11 April 2015

02 September 2015

Publication Date:
28 October 2015 (online)

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Abstract

Objective To evaluate whether a secondary increase of serum lactate levels in asphyxiated newborns during hypothermia treatment may reflect suboptimal dynamics.

Methods–Retrospective case series and review of the literature. We present the clinical course of four asphyxiated newborns treated with hypothermia who presented with hypotension requiring inotropic support, and who displayed a secondary increase of serum lactate levels during hypothermia treatment. Serial serum lactate levels are correlated with blood pressure and inotropic support within the first 96 hours of life.

Results Lactate levels initially decreased in the four patients. However, each of them started to present lower blood pressure, and lactate levels started to increase again. Inotropic support was started to raise blood pressure. The introduction of an epinephrine drip consistently worsened the increase of lactate levels in these newborns, whereas dopamine and dobutamine enabled the clearance of lactate in addition to raising the blood pressure. Rewarming was associated with hemodynamics perturbations (a decrease of blood pressure and/or an increase of lactate levels) in the three newborns who survived.

Conclusions Lactate levels during the first 4 days of life should be followed as a potential marker for suboptimal hemodynamic status in term asphyxiated newborns treated with hypothermia, for whom the maintenance of homeostasis during hypothermia treatment is of utmost importance to alleviate brain injury.

Keywords

birth asphyxia - hemodynamics - lactate - neonatal encephalopathy - newborn brain
 

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