Umbilical Artery Lactate Correlates with Brain Lactate in Term Infants

Abstract

Objective The objective of this study was to determine the correlation between umbilical artery lactate with brain lactate in nonanomalous term infants.

Study Design We performed a nested case–control study within an on-going prospective cohort of more than 8,000 consecutive singleton term (≥ 37 weeks) nonanomalous infants. Neonates underwent cerebral magnetic resonance imaging (MRI) within the first 72 hours of life. Cases (umbilical artery pH ≤ 7.10) were gender and race matched 1:3 to controls (umbilical artery pH > 7.20). Single voxel magnetic resonance spectroscopy (MRS), lactate, and N-acetyl aspartate (NAA) for normalization were calculated using Siemens software (Plano, TX). Linear regression estimated the association between incremental change in umbilical artery lactate and brain lactate, both directly and as a ratio with NAA.

Results Of 175 infants who underwent MRI with spectral sequencing, 52 infants had detectable brain lactate. The 52 infants with brain lactate peaks had umbilical artery lactate values of 1.6 to 11.4 mmol/L. For every 1.0 mmol/L increase in umbilical artery lactate, there was an increase in brain lactate of 0.02, which remained significant even when corrected for NAA.

Conclusion MRS measured brain lactate is significantly correlated with umbilical artery lactate in nonanomalous term infants, which may help explain the observed association between umbilical artery lactate and neurologic morbidity.

Keywords

cerebral lactate - umbilical artery lactate - brain injury - magnetic resonance spectroscopy

Note

This study was presented orally as an abstract at the 34th annual meeting of the Society of Maternal and Fetal Medicine, New Orleans, LA, February 3–8, 2014.

• References

• 1 Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anest Anal 1953; 32 (4) 260-267
• 2 Kruger K, Hallberg B, Blennow M, Kublickas M, Westgren M. Predictive value of fetal scalp blood lactate concentration and pH as markers of neurologic disability. Am J Obstet Gynecol 1999; 181 (5 Pt 1): 1072-1078
• 3 Allen RM, Bowling FG, Oats JJ. Determining the fetal scalp lactate level that indicates the need for intervention in labour. Aust N Z J Obstet Gynaecol 2004; 44 (6) 549-552
• 4 Wiberg N, Källén K, Herbst A, Olofsson P. Relation between umbilical cord blood pH, base deficit, lactate, 5-minute Apgar score and development of hypoxic ischemic encephalopathy. Acta Obstet Gynecol Scand 2010; 89 (10) 1263-1269
• 5 Gjerris AC, Staer-Jensen J, Jørgensen JS, Bergholt T, Nickelsen C. Umbilical cord blood lactate: a valuable tool in the assessment of fetal metabolic acidosis. Eur J Obstet Gynecol Reprod Biol 2008; 139 (1) 16-20
• 6 Nordström L, Malcus P, Chua S, Shimojo N, Arulkumaran S. Lactate and acid-base balance at delivery in relation to cardiotocography and T/QRS ratios in the second stage of labour. Eur J Obstet Gynecol Reprod Biol 1998; 76 (2) 157-160
• 7 Gunn AJ, Bennet L. Fetal hypoxia insults and patterns of brain injury: insights from animal models. Clin Perinatol 2009; 36 (3) 579-593
• 8 Xu D, Vigneron D. Magnetic resonance spectroscopy imaging of the newborn brain--a technical review. Semin Perinatol 2010; 34 (1) 20-27
• 9 Moffett JR, Ross B, Arun P, Madhavarao CN, Namboodiri AM. N-Acetylaspartate in the CNS: from neurodiagnostics to neurobiology. Prog Neurobiol 2007; 81 (2) 89-131
• 10 Zeisel SH. Nutritional importance of choline for brain development. J Am Coll Nutr 2004; 23 (6, Suppl): 621S-626S
• 11 Barkovich AJ, Miller SP, Bartha A , et al. MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy. Am J Neuroradiol 2006; 27 (3) 533-547
• 12 Wolf RL, Zimmerman RA, Clancy R, Haselgrove JH. Quantitative apparent diffusion coefficient measurements in term neonates for early detection of hypoxic-ischemic brain injury: initial experience. Radiology 2001; 218 (3) 825-833
• 13 Leth H, Toft PB, Peitersen B, Lou HC, Henriksen O. Use of brain lactate levels to predict outcome after perinatal asphyxia. Acta Paediatr 1996; 85 (7) 859-864
• 14 Cowan FM, Pennock JM, Hanrahan JD, Manji KP, Edwards AD. Early detection of cerebral infarction and hypoxic ischemic encephalopathy in neonates using diffusion-weighted magnetic resonance imaging. Neuropediatrics 1994; 25 (4) 172-175
• 15 Munkeby BH, De Lange C, Emblem KE , et al. A piglet model for detection of hypoxic-ischemic brain injury with magnetic resonance imaging. Acta Radiol 2008; 49 (9) 1049-1057
• 16 Nelson SJ. Analysis of volume MRI and MR spectroscopic imaging data for the evaluation of patients with brain tumors. Magn Reson Med 2001; 46 (2) 228-239
• 17 Thayyil S, Chandrasekaran M, Taylor A , et al. Cerebral magnetic resonance biomarkers in neonatal encephalopathy: a meta-analysis. Pediatrics 2010; 125 (2) e382-e395
• 18 Miller SP, McQuillen PS, Hamrick S , et al. Abnormal brain development in newborns with congenital heart disease. N Engl J Med 2007; 357 (19) 1928-1938
• 19 Holshouser BA, Ashwal S, Shu S, Hinshaw Jr DB. Proton MR spectroscopy in children with acute brain injury: comparison of short and long echo time acquisitions. J Magn Reson Imaging 2000; 11 (1) 9-19
• 20 Haseler LJ, Arcinue E, Danielsen ER, Bluml S, Ross BD. Evidence from proton magnetic resonance spectroscopy for a metabolic cascade of neuronal damage in shaken baby syndrome. Pediatrics 1997; 99 (1) 4-14
• 21 Tuuli MG, Stout MJ, Shanks A, Odibo AO, Macones GA, Cahill AG. Umbilical cord arterial lactate compared with pH for predicting neonatal morbidity at term. Obstet Gynecol 2014; 124 (4) 756-761