Association between urinary lactate to creatinine ratio and neurodevelopmental outcome in term infants with hypoxic-ischemic encephalopathy.

Full Abstract

OBJECTIVE:
To assess the association between urinary lactate to creatinine ratio (ULCR) and neurodevelopmental outcome in term infants with hypoxic ischemic encephalopathy and examine the effect of hypothermia on the change in ULCR.

STUDY DESIGN:
Spot urine samples were collected in 58 term infants (28 hypothermia, 30 control subjects) with hypoxic ischemic encephalopathy. Urinary lactate and creatinine were measured by using (1)H nuclear magnetic resonance spectroscopy and expressed as ULCR. Survivors were examined at 18 months of age.

RESULTS:
The ULCR was significantly higher in infants who died or had moderate/severe neurodevelopmental disability. Logistic regression analysis controlling for hypothermia and severity of encephalopathy confirmed the association (adjusted odds ratio, 5.52; 95% CI, 1.36, 22.42; P < .02). Considerable overlap in ULCR was observed between infants with normal/mild disability and those who died or survived with moderate/severe disability. ULCR fell significantly between 6 and 24 hours and 48 and 72 hours of age for all infants. The magnitude of decline did not differ between hypothermia and control groups.

CONCLUSIONS:
High ULCR is associated with death or moderate/severe neurodevelopmental disability. Significant overlap in values between the normal/mild and moderate/severe disability groups limits predictive value of this measure. Whole-body hypothermia did not affect the decline in ULCR.

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Author information

Author/s: Oh, William (W); Perritt, Rebecca (R); Shankaran, Seetha (S); Merritts, Matthew (M); Donovan, Edward F (EF); Ehrenkranz, Richard A (RA); O'Shea, T Michael (TM); Tyson, Jon E (JE); Laptook, Abbot R (AR); Das, Abhik (A); Higgins, Rosemary D (RD);

Affiliation: Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.

Grants: 5 M01 RR00044 (Agency:United States NCRR) ; M01 RR 00070 (Agency:United States NCRR) ; M01 RR 00125 (Agency:United States NCRR) ; M01 RR 0039-43 (Agency:United States NCRR) ; M01 RR 00750 (Agency:United States NCRR) ; M01 RR 08084 (Agency:United States NCRR) ; M01RR 00039 (Agency:United States NCRR) ; U01 HD36790 (Agency:United States NICHD) ; U10 HD 21373 (Agency:United States NICHD) ; U10 HD21385 (Agency:United States NICHD) ; U10 HD27851 (Agency:United States NICHD) ; U10 HD27853 (Agency:United States NICHD) ; U10 HD27856 (Agency:United States NICHD) ; U10 HD27871 (Agency:United States NICHD) ; U10 HD27880 (Agency:United States NICHD) ; U10 HD27904 (Agency:United States NICHD) ; U10 HD34216 (Agency:United States NICHD) ; U10 HD40498 (Agency:United States NICHD) ; U10 HD40521 (Agency:United States NICHD) ; U10 HD40689 (Agency:United States NICHD)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural

Journal: The Journal of pediatrics (J Pediatr), published in United States. (Language: eng)

Reference: 2008-Sep; vol 153 (issue 3) : pp 375-8

Dates: Created 2008/08/22; Completed 2008/09/09;

PMID: 18534246, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Biological Markers - urine
Child Development - physiology
Creatinine - urine
Female
Follow-Up Studies
Humans
Hypothermia, Induced
Hypoxia-Ischemia, Brain - physiopathology; therapy; urine

Associated Chemicals: Biological Markers (0) ; Lactic Acid (50-21-5) ; Creatinine (60-27-5)

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