PEDIATRICS Vol. 96 No. 5 November 1995, pp. 914-917
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Elevated Serum Lactate Correlates With Intracranial Hemorrhage in Neonates Treated With Extracorporeal Life Support

Eva Nozik Grayck MD1, Jon N. Meliones MD1, Frank H. Kern MD1, Doug R. Hansell RRT, MD1, Ross M. Ungerleider MD1, and William J. Greeley MD1

1 Departments of Pediatrics, Anesthesiology, and Surgery, Duke University Medical Center, Durham, NC 27710

Objectives. To correlate the initial and maximal lactate levels with the occurrence of intracranial hemorrhage (ICH) and survival in patients treated with extracorporeal life support (ECLS).

Design. Retrospective chart review.

Setting. Pediatric intensive care unit.

Patients. Eighty-two neonatal patients placed on ECLS for respiratory failure due to sepsis, meconium aspiration, or persistent pulmonary hypertension of the newborn.

Measurements. The initial lactate level measured within 6 hours of initiating ECLS and the maximal lactate level measured throughout the ECLS course were collected. Lactate levels were described as mean lactate ± SE (mM). Head ultrasound reports and survival were reviewed. Platelet counts and activated clotting times (ACTs) were examined.

Results. The mean initial and maximal lactate levels were higher in ECLS patients who developed ICH (initial: 10 ± 1.7 mM vs 6.4 ± 0.8 mM, p = .05 and maximal: 12.4 ± 2.5 mM vs 7.9 ± 0.8 mM, p = .04). Initial and maximal lactate levels were also elevated in nonsurvivors (initial: 11.7 ± 3 mM vs 6.4 ± 0.7 mM, p = .01 and maximal: 14.8 ± 3.3 mM vs 7.8 ± 0.8 mM, P < .01). Platelet counts and ACT did not differ in patients with and without ICH.

Conclusions. Lactate is a useful marker for the development of ICH in ECLS patients. In addition, elevated lactates during ECLS identify a subgroup of patients with poor outcome. Prospective studies are needed to determine whether the incorporation of this information into pre-ECLS and ECLS management will decrease the occurrence of ICH and improve survival.

Submitted on June 21, 1994
Accepted on December 28, 1994




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