Long-term neurodevelopmental effects of exclusively high cord lactate levels in term newborn

Abstract

Introduction

Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia.

Methods

This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases (n = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, n = 92) and those with low lactate levels (below 2 mmol/L, n = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, n = 29, and high lactate group, n = 45) were evaluated.

Results

No difference was observed between the two groups in terms of demographic characteristics such as age (p = .1669), male gender (p = .906), mother’s working situation (p = .948), mother’s education level (p = .828), father’s education level (p = .507), and family’s total income (p = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, p = .001), problem-solving (50 vs. 60, p = .002), and personal social development (45 vs. 60, p = .003). No difference was observed in terms of communication and gross motor total scores.

Discussion

In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.

Keywords:

• Neonates
• Apgar score
• neurodevelopment
• outcomes
• umbilical cord blood gases

Author contributions

Conception – A.Y., M.V.; design – A.Y., M.V., Y.P.; supervision – Y.P., M.V.; materials – A.Y., M.N.C., G.Y., G.K., M.V., Y.P.; data collection and/or processing – A.Y., M.N.C., G.Y, G.K., S.N.A., M.V., Y.P.; analysis and/or interpretation – A.Y., S.N.A.; literature review – A.Y., M.N.C., G.Y.; writing – A.Y., M.V.; critical review – A.Y., Y.P, M.V. All authors read and approved the final manuscript.

Ethical approval

Ethics approval was obtained from the Ethics Committee of the Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa (date: 11/12/2020, reference no.: 162202) conducted under the Declaration of Helsinki.

Consent form

An informed consent document with information about the study and following the requirements established by the "Ethics Committee of the Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa” was offered to the parents. Informed consent was obtained from parents.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available due to our hospital policy but are available from the corresponding author upon reasonable request.

Additional information

Funding

There is no funding.