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Should we act on a high umbilical cord lactate in an otherwise healthy neonate?
  1. Jennifer Beth Salvanos
  1. General Paediatrics, Sheffield Children's Hospital, Sheffield, UK
  1. Correspondence to Dr Jennifer Beth Salvanos, Sheffield Children's Hospital, Sheffield S10 2TH, UK; jennifer.salvanos{at}nhs.net

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Question

Should we act on a high umbilical cord lactate in an otherwise healthy neonate?

Clinical scenario

While on call for neonatology, you are called by a midwife who asks you to review a baby because the cord lactate was elevated at 4.5 mmol/L. The baby was just delivered at term following a normal pregnancy via emergency caesarean section for failure to progress. It is routine practice at your hospital to do a cord gas on all babies born in theatre. The baby had good Apgar scores, did not need any resuscitation and is breastfeeding in the recovery room. There was no meconium or risk factors for sepsis. You ask yourself what is the neonatal outcome predictor of a high cord lactate in term babies who did not need resuscitation?

Structured clinical question

In well-term neonates (population), does umbilical cord lactate (intervention) correlate with neonatal outcome (outcome)?

Search strategy

Primary search was done on Ovid Medline Embase using the search terms: (term.mp OR exp.term birth) AND (neonat*.mp OR exp.newborn) AND (cord.mp OR exp.umbilical cord/umbilical cord blood) AND (lactate.mp OR exp.lactic acid) AND ((morbidity.mp OR exp.morbidity/perinatal morbidity/newborn morbidity) OR (outcome.mp OR exp.fatal outcome/adverse outcome pathways/patient outcome assessment)), limited to English language. Sixty potential papers were reviewed. Studies only comparing lactate to other cord measurements were excluded and those only assessing acidotic or high risk, including preterm, neonates were excluded. However, several studies included in the systematic review gave no inclusion criteria. A total of five papers were found relevant for inclusion, one systemic review and four cohort studies (see table 1). A …

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