Prediction of Respiratory Morbidities in Late Preterm Neonates Using Cord Blood Arterial Lactate and Base Excess

Document Type : Original Article


1 Department of Paediatrics, Kodagu Institute of Medical Sciences and Teaching Hospital, Madikeri, Karnataka, India

2 Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India


Background: Late preterm neonates may have the external appearance and behavior similar to their counterparts.
However, they are susceptible to various neonatal morbidities , due to their physiological and metabolical immaturity.
To assess the correlation between cord blood arterial lactate levels and base excess with the development of
respiratory distress in late preterm neonates.
Methods: All inborn neonates born at Kasturba hospital Manipal, satisfying the criteria of late preterm infants (34 -36
6/7 weeks) were included in this prospective observational study.The data recorded included gender, birth weight,
multiple births, presence of major congenital anomalies, mode of delivery, APGAR score at minute 5, need for
resuscitation, admission to the neonatal intensive care unit (NICU), and days of hospitalization. Lactate and base excess
were estimated using blood obtained from umbilical artery sampling. The primary outcome assessed was the
requirement of delivery room resuscitation. The secondary outcomes assessed were the development of respiratory
distress, requirement of invasive/non- invasive ventilation, and respiratory support.
Results: Cord blood base excess levels were significantly higher in late preterm neonates requiring delivery room
resuscitation compared to those who did not require resuscitation (median: -8 vs -4mEq/L, p-value: 0.002).In terms of
respiratory morbidities, cord blood base excess levels were significantly higher in neonates with respiratory distress
syndrome (RDS)(median: -8.5 vs -3.4 mEq/L, p-value 0.001), and transient tachypnea of newborn (TTNB) (median: -8
vs -3.4 mEq/L, p-value 0.004), compared to those without RDS and TTNB.However,there was no signi icant association
between cord blood lactate levels and the outcomes assessed.
Conclusion: Estimation of arterial base excess levels obtained from umbilical cord blood sampling during delivery may
serve as a sensitive marker for predicting respiratory morbidities in late preterm neonates.


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