Secondary Increase of Lactate Levels in Asphyxiated Newborns during Hypothermia Treatment: Reflect of Suboptimal Hemodynamics (A Case Series and Review of the Literature).
Secondary Increase of Lactate Levels in Asphyxiated Newborns during Hypothermia Treatment: Reflect of Suboptimal Hemodynamics (A Case Series and Review of the Literature).
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DOI：
10.1055/s-0035-1565921
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发表时间：
2016-03
期刊：
影响因子：
0.9
通讯作者：
Wintermark P
中科院分区：
文献类型：
--
作者：
Al Balushi A;Guilbault MP;Wintermark P
目的探讨窒息新生儿在低温治疗过程中血清乳酸水平的二次升高是否反映了亚理想动力学。方法：回顾性病例系列和文献回顾。我们介绍了4例接受低温治疗的窒息新生儿的临床过程，这些新生儿表现为低血压，需要肌力支持，并且在低温治疗期间显示血清乳酸水平的二次增加。连续血清乳酸水平与生命前96小时内的血压和肌力支持相关。结果4例患者初始乳酸水平均有所下降。然而，他们每个人的血压都开始下降，乳酸水平又开始上升。肌力支持开始提高血压。在这些新生儿中，肾上腺素滴注持续加剧了乳酸水平的升高，而多巴胺和多巴酚丁胺除了升高血压外，还能清除乳酸。在存活的3名新生儿中，复温与血流动力学紊乱（血压降低和/或乳酸水平升高）有关。结论对于低温治疗的足月窒息新生儿，应追踪其出生后4天的乳酸水平，作为血液动力学状态不佳的潜在标志，低温治疗期间维持体内平衡对减轻脑损伤至关重要。
Objective To evaluate whether a secondary increase of serum lactate levels in asphyxiated newborns during hypothermia treatment may reflect suboptimal dynamics. Methods–Retrospective case series and review of the literature. We present the clinical course of four asphyxiated newborns treated with hypothermia who presented with hypotension requiring inotropic support, and who displayed a secondary increase of serum lactate levels during hypothermia treatment. Serial serum lactate levels are correlated with blood pressure and inotropic support within the first 96 hours of life. Results Lactate levels initially decreased in the four patients. However, each of them started to present lower blood pressure, and lactate levels started to increase again. Inotropic support was started to raise blood pressure. The introduction of an epinephrine drip consistently worsened the increase of lactate levels in these newborns, whereas dopamine and dobutamine enabled the clearance of lactate in addition to raising the blood pressure. Rewarming was associated with hemodynamics perturbations (a decrease of blood pressure and/or an increase of lactate levels) in the three newborns who survived. Conclusions Lactate levels during the first 4 days of life should be followed as a potential marker for suboptimal hemodynamic status in term asphyxiated newborns treated with hypothermia, for whom the maintenance of homeostasis during hypothermia treatment is of utmost importance to alleviate brain injury.