PLASMA AND URINARY LACTATE FOR DIAGNOSIS OF EARLY ONSET SEPSIS IN NEONATES

Abstract

Background: Monitoring tissue perfusion in sepsis is essential for the early detection of circulatory failure, timely initiation of appropriate interventions, and assessment of therapeutic response. Inadequate oxygen delivery leads to elevated lactate levels, which have been shown to predict morbidity and mortality in newborns. However, limited research has explored the role of lactate measurements in the diagnosis and prognosis of neonatal sepsis. Aim: To determine the minimum threshold levels of plasma and urinary lactate useful for diagnosing early-onset sepsis (EOS). Materials and Methods: This study included ninety neonates at risk for EOS. Sepsis screening, blood culture, plasma lactate (within the first two hours of life), and urinary lactate (from the first urine sample) were assessed. At 24 ± 2 hours of life, repeat measurements of C-reactive protein (CRP), plasma lactate, and urinary lactate were obtained. Results: In the sepsis group, the median urinary lactate levels in the first urine sample and at 24 hours were 0.50 mMol/L and 0.45 mMol/L, respectively. In the non-sepsis group, the corresponding values were 0.37 mMol/L and 0.43 mMol/L. Neither plasma nor urinary lactate levels were reliable for diagnosing EOS. However, urinary lactate at 24 hours demonstrated utility as a diagnostic marker for sepsis associated with shock and mortality. Conclusion: Plasma and urinary lactate levels do not predict EOS. Nonetheless, urinary lactate measured at 24 hours of life may serve as an indicator for shock and mortality in infants with EOS.