A comparison study of blood lactate and lactate clearance with SNAP II score as predictors of outcome in sick neonates

Abstract

Introduction: Necessity of longer stay in NICU reinforces the need for more sensible and specific parameter to evaluate the length of stay and outcome. In order to improve the clinical outcomes in sick neonates, it is crucial to obtain early recognition of those who are at risk of morbidity and mortality and to optimize the clinical decision making in a timely manner and to counsel the parents.

Aims & Objectives: This study was designed to compare and obtain best predictor of outcome irrespective of diagnosis.

Materials and Methods: The study was “prospective observational” study, conducted at NICU over 188 sick neonates of Pragna hospitals, Hyderabad in the period of October 2013 to september2015.

Results: Among 188 sick neonates 20 were non survivors, and 168 survived. There was significant correlation between high lactate at admission, low LAC24 of less than 30% and high SNAP II score at admission with mortality among sick neonates. Neonates with LAC24 of < 30% had significantly higher requirement of oxygen (p-0.00*), fluid support (p-0.00*), ionotropes(p-0.0002**), ventilator support(p-0.0015**) and length of stay(p-0.004*) than with LAC24> 60%. There were 23 neonates with initial lactate of more than 9mmol/dl. 6 out of 23 had LAC24 of less than 30%. 4 out of 6 had LAC48 of more than 30% yet, all 6 neonates had prolonged duration of stay with an average of 15.3 days. Neonates with high SNAP II score at admission of more than 60 had higher requirement ionotrope, and ventilator support. The area under curve (ROC) revealed poor correlation with overall morbidity.

Conclusion: Lactate clearance value of less than 20.4% at 24 hours of admission could be useful to predict the adverse outcome with significant need for mechanical ventilation, higher oxygen, fluid and inotrope support and prolonged stay in sick neonates irrespective of diagnosis