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The prognostic value of initial blood lactate concentration measurements in very low birthweight infants and their use in development of a new disease severity scoring system
  1. Louise A Phillips1,
  2. Chris J Dewhurst2,
  3. Charles William Yoxall2
  1. 1Paediatrics Department, Ysbyty Glan Clwyd, Rhyl, Denbighshire, UK
  2. 2Neonatology Department, Liverpool Women's Hospital, Liverpool, Merseyside, UK
  1. Correspondence to Dr Louise Phillips, Ysbyty Glan Clwyd, Rhyl, Denbighshire LL18 5UJ, UK; Louise.Phillips2{at}wales.nhs.uk

Abstract

Objectives To investigate the predictive value of the Clinical Risk Index for Babies (CRIB) score in current practise, the predictive value of blood lactate concentrations ([L]) and to develop a new clinical scoring system for very low birthweight (VLBW) babies.

Methods The predictive ability of CRIB, [L] and the development of the new score was based on retrospective data collected from all inborn VLBW babies born between March 2001 and February 2004 in a tertiary neonatal unit. Predictive ability was determined from area under the receiver operator curve (AUC). A new score was developed and validated with a second cohort of VLBW babies.

Results 408 babies were studied in the development cohort and 275 in the validation cohort. AUC for CRIB was 0.933 (95% CI 0.897-0.969). Initial [L] was significantly higher in babies who died than in those who survived (median (range) 9.2 (1.26–21.1) vs 3.64 (0.67– 17.9) mmol/l, p<0.0001) as was the highest [L] in the first 12 h (10.2 (3.37–26) vs 3.84 (1.05–20.7) mmol/l, p<0.0001). A new score was developed using; highest [L], gestation and the presence of life-threatening malformation. AUC for the new score was 0.918 (95% CI 0.876-0.961) in the development cohort and 0.859 (95% CI 0.805-0.913) in the validation cohort.

Conclusions CRIB score retains its predictive ability for mortality in VLBW babies. Early hyperlactataemia is a predictor of death in VLBW babies. The new score appears to perform as well as CRIB but requires fewer data items.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Liverpool Paediatric Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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