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Published on: August 19, 2020
Acid-base disorders in critically ill neonates
S Lekhwani1, V Shanker, G Gathwala
1Department of Biochemistry, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India.
Insights
Metabolic acidosis is common in neonates with serious illnesses like birth asphyxia. High lactate levels indicate severe illness and predict mortality in these infants.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Clinical Chemistry
Background:
- Acid-base imbalance is a critical concern in neonates with various pediatric diseases.
- Common conditions include sepsis, bronchopneumonia, diarrhea, and birth asphyxia, often presenting in emergency settings.
Purpose of the Study:
- To investigate the prevalence and characteristics of acid-base disorders in neonates with common pediatric diseases.
- To evaluate the role of plasma lactate in assessing metabolic acidosis and predicting mortality.
Main Methods:
- An observational study involving 50 neonates (0-1 month) in a tertiary care hospital's emergency room.
- Analysis included blood gas, electrolytes, plasma lactate, and plasma albumin levels.
Main Results:
- Metabolic acidosis was the most frequent acid-base disorder, with hyperlactatemia in over half of affected neonates.
- Birth asphyxia showed the highest mortality, followed by bronchopneumonia and sepsis.
- A significant correlation was found between critical lactate values and mortality.
Conclusions:
- Birth asphyxia with elevated lactate levels significantly impacts acid-base status in neonates.
- Plasma lactate measurement is crucial for diagnosing metabolic acidosis and predicting mortality in critically ill neonates.
Objective:
To study acid-base imbalance in common pediatric diseases (such as sepsis, bronchopneumonia, diarrhea, birth-asphyxia etc.) in neonates.
Design And Setting:
An observational study was conducted in an emergency room of a tertiary teaching care hospital in Haryana, India.
Patients And Methods:
Fifty neonates (from first hour to one month) attending pediatric emergency services with various ailments. Blood gas analysis, electrolytes, plasma lactate, and plasma albumin were estimated in neonates.
Results:
Metabolic acidosis was the most common acid-base disorder. Hyperlactatemia was observed in more than half of such cases. Birth asphyxia was another common disorder with the highest mortality in neonates followed by bronchopneumonia and sepsis. Significant correlation between mortality and critical values of lactate was observed.
Conclusion:
Birth asphyxia with high-lactate levels in neonates constituted major alterations in acid-base disorders seen in an emergency room of a tertiary teaching care hospital. Plasma lactate concentration measurement provides an invaluable tool to assess type of metabolic acidosis in addition to predicting mortality in these neonates.
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