Relationship between plasma D-lactate levels and prognosis of neonatal necrotizing enterocolitis

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CHEN Dong-mei(Department of Neonatal Intensive Care Unit, Quanzhou Children's Hospital, Fujian Province ,Quanzhou 362000,China)
LEI Guo-feng(Department of Neonatal Intensive Care Unit, Quanzhou Children's Hospital, Fujian Province ,Quanzhou 362000,China)
PENG Wei-lin(Department of Neonatal Intensive Care Unit, Quanzhou Children's Hospital, Fujian Province ,Quanzhou 362000,China)
Journal Title:
Chinese Journal of Perinatal Medicine
Volume 14, Issue 10, 2011
Key Word:
Enterocolitis, necrotizing;Lactic acid;Infant, newborn;Prognosis

Abstract: Objective To investigate the relationship between plasma D-lactate levels and prognosis in newborns with neonatal necrotizing enterocolitis (NEC).Methods One hundred and four premature infants with NEC (stase Ⅱ and Ⅲ ) and another 104 premature infants without NEC admitted into Quanzhou Children's Hospital for other diseases from January 2007 to October 2010 were selected into this case control study.The gestational age,gender and birth weight of patients in the two groups were matched.NEC patients' bloods were collected within 24 hours after NEC was confirmed and blood samples of the control group were collected at the corresponding age.Enzymelinked immunosorbent assay was used to detect the plasma D-lactate level.Receiver operating characteristic curve was used to confirm the criteria of D-lactate positive,according to which,the NEC group was divided into high D-lactate group and normal D-lactate group,and the mortality and complication rate of the two groups were compared with x2 test.And NEC group was subdivided into death group and survive group according to the prognosis of the patients,and the difference of D-lactate level between the two groups were compared with t test.Results Among the NEC group,there were 63 cases (60.6%) of stage Ⅱ and 41 (39.4%) cases of stage Ⅲ ; 88 (84.6%) survived infants and 16 (15.4%) dead infants.D-lactate level was (35.4 ± 29.1) μg /ml in stage Ⅲ NEC group,(29.5±16.2) μg/ml in stage Ⅱ NEC group and (3.7±18.4) μg/ml in control group; there were statistical differences between each other(F=5.97,P<0.05).Receiver operating characteristic curve analysis showed that if 6 μg/ml was set as the borderline,there were 87 cases(83.7%,87/104) with high D-lactate patients in NEC group,whose neonatal critical illness scoring (NCIS) was 80.9±22.6,significantly lower than that of normal D-lactate patients ( 95.8 ± 20.5) (t =2.417,P< 0.05),and higher neonatal septicemia rate (48.3%,42/87) and mortality (27.6%,24/87) compared with those [(5.9%,1/17) and (5.9%,1/17)] of normal D-lactate patients(x2 =11.539 and 7.146,P<0.05,respectively).In NEC group,compared with the survived infants,the D-lactate level [(43.2±13.5) μg/ml vs (21.9 ± 22.9) μg/ml,t =4.572,P<0.05] and the rate of septicemia [68.8% (11/16) vs 38.6% (34/88),x2 =3.445,P<0.05] were higher in dead patients,and NCIS (82.4± 29.1 vs 90.6 ± 21.3,t =2.409,P<0.05) was lower.Conctusions The level of plasma D-lactate related to the prognosis of neonatal NEC and which might be a good indicator for its prognosis and severity.

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