Persistent lactic acidosis in neonatal hypoxic-ischaemic encephalopathy correlates with EEG grade and electrographic seizure burden.

Hdl Handle:
http://hdl.handle.net/10147/209294
Title:
Persistent lactic acidosis in neonatal hypoxic-ischaemic encephalopathy correlates with EEG grade and electrographic seizure burden.
Authors:
Murray, D M; Boylan, G B; Fitzgerald, A P; Ryan, C A; Murphy, B P; Connolly, S
Affiliation:
Department of Paediatrics and Child Health, Clinical Investigations Unit, Cork, University Hospital, Ireland. d.murray@ucc.ie
Citation:
Arch Dis Child Fetal Neonatal Ed. 2008 May;93(3):F183-6. Epub 2006 Nov 28.
Journal:
Archives of disease in childhood. Fetal and neonatal edition
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209294
DOI:
10.1136/adc.2006.100800
PubMed ID:
17132680
Abstract:
BACKGROUND: Predicting at birth which infants with perinatal hypoxic-ischaemic injury will progress to significant encephalopathy remains a challenge. OBJECTIVE: To determine whether lactic acidosis at birth in asphyxiated neonates could predict the grade of EEG encephalopathy by examining the relationship between time taken for the normalisation of lactate, severity of encephalopathy and seizure burden. METHODS: Continuous early video-EEG monitoring was performed in babies at risk for hypoxic-ischaemic encephalopathy. Encephalopathy was graded from the EEG data. Total seizure burden (seconds) was calculated for each baby. Initial blood gas measurements of pH, base deficit and lactate were taken within 30 minutes of delivery. Time to normal serum lactate was determined in hours from birth for each infant. RESULTS: All 50 term infants had raised initial serum lactate (median (lower, upper quartiles) 11.7 (10.2, 14.9)). There were no significant differences between the initial serum lactate, pH and base deficit in infants with normal/mildly abnormal (n = 24), moderately abnormal (n = 14), severely abnormal (n = 5) and inactive EEGs (n = 7). Time to normal lactate varied significantly with EEG grade (median (lower, upper quartile) 6.0 (4.1, 9.5) for mild/normal EEG, 13.5 (6.8, 23.5) moderate EEG, 41.5 (30.0, 55.5) severe group, 12.0 (8.1, 21.5) inactive group; p<0.001). Time to normal lactate correlated significantly with EEG seizure burden (seconds; R = 0.446, p = 0.002). Mean (SD) time to normal lactate was 10.0 (7.2) hours in infants who did not have seizures and 27.3 (19.0) hours in the 13 infants with electrographic seizures (p = 0.002). CONCLUSIONS: Serum lactate levels in the first 30 minutes of life do not predict the severity of the ensuing encephalopathy. In contrast, sustained lactic acidosis is associated with severe encephalopathy on EEG and correlates with seizure burden.
Language:
eng
MeSH:
Acidosis, Lactic/*complications; Asphyxia Neonatorum/*complications; Electroencephalography/methods; Female; Humans; *Hypoxia-Ischemia, Brain/complications/diagnosis; Infant, Newborn; Lactic Acid/blood; Male; Monitoring, Physiologic/methods; Prognosis; Prospective Studies; Seizures/*complications; Severity of Illness Index; Time Factors; Video Recording
ISSN:
1468-2052 (Electronic); 1359-2998 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMurray, D Men_GB
dc.contributor.authorBoylan, G Ben_GB
dc.contributor.authorFitzgerald, A Pen_GB
dc.contributor.authorRyan, C Aen_GB
dc.contributor.authorMurphy, B Pen_GB
dc.contributor.authorConnolly, Sen_GB
dc.date.accessioned2012-02-03T15:17:26Z-
dc.date.available2012-02-03T15:17:26Z-
dc.date.issued2012-02-03T15:17:26Z-
dc.identifier.citationArch Dis Child Fetal Neonatal Ed. 2008 May;93(3):F183-6. Epub 2006 Nov 28.en_GB
dc.identifier.issn1468-2052 (Electronic)en_GB
dc.identifier.issn1359-2998 (Linking)en_GB
dc.identifier.pmid17132680en_GB
dc.identifier.doi10.1136/adc.2006.100800en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209294-
dc.description.abstractBACKGROUND: Predicting at birth which infants with perinatal hypoxic-ischaemic injury will progress to significant encephalopathy remains a challenge. OBJECTIVE: To determine whether lactic acidosis at birth in asphyxiated neonates could predict the grade of EEG encephalopathy by examining the relationship between time taken for the normalisation of lactate, severity of encephalopathy and seizure burden. METHODS: Continuous early video-EEG monitoring was performed in babies at risk for hypoxic-ischaemic encephalopathy. Encephalopathy was graded from the EEG data. Total seizure burden (seconds) was calculated for each baby. Initial blood gas measurements of pH, base deficit and lactate were taken within 30 minutes of delivery. Time to normal serum lactate was determined in hours from birth for each infant. RESULTS: All 50 term infants had raised initial serum lactate (median (lower, upper quartiles) 11.7 (10.2, 14.9)). There were no significant differences between the initial serum lactate, pH and base deficit in infants with normal/mildly abnormal (n = 24), moderately abnormal (n = 14), severely abnormal (n = 5) and inactive EEGs (n = 7). Time to normal lactate varied significantly with EEG grade (median (lower, upper quartile) 6.0 (4.1, 9.5) for mild/normal EEG, 13.5 (6.8, 23.5) moderate EEG, 41.5 (30.0, 55.5) severe group, 12.0 (8.1, 21.5) inactive group; p<0.001). Time to normal lactate correlated significantly with EEG seizure burden (seconds; R = 0.446, p = 0.002). Mean (SD) time to normal lactate was 10.0 (7.2) hours in infants who did not have seizures and 27.3 (19.0) hours in the 13 infants with electrographic seizures (p = 0.002). CONCLUSIONS: Serum lactate levels in the first 30 minutes of life do not predict the severity of the ensuing encephalopathy. In contrast, sustained lactic acidosis is associated with severe encephalopathy on EEG and correlates with seizure burden.en_GB
dc.language.isoengen_GB
dc.subject.meshAcidosis, Lactic/*complicationsen_GB
dc.subject.meshAsphyxia Neonatorum/*complicationsen_GB
dc.subject.meshElectroencephalography/methodsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.mesh*Hypoxia-Ischemia, Brain/complications/diagnosisen_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.meshLactic Acid/blooden_GB
dc.subject.meshMaleen_GB
dc.subject.meshMonitoring, Physiologic/methodsen_GB
dc.subject.meshPrognosisen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshSeizures/*complicationsen_GB
dc.subject.meshSeverity of Illness Indexen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshVideo Recordingen_GB
dc.titlePersistent lactic acidosis in neonatal hypoxic-ischaemic encephalopathy correlates with EEG grade and electrographic seizure burden.en_GB
dc.contributor.departmentDepartment of Paediatrics and Child Health, Clinical Investigations Unit, Cork, University Hospital, Ireland. d.murray@ucc.ieen_GB
dc.identifier.journalArchives of disease in childhood. Fetal and neonatal editionen_GB
dc.description.provinceMunster-

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