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Clinical application of the measurement of cord plasma lactate and pyruvate in the assessment of high‐risk neonates

Lactate levels in combination with lactate/pyruvate (L/P) ratio have been used to measure altered cellular redox states. We measured the cord plasma lactate levels and L/P ratios in 70 normal neonates (40 full‐term and 30 preterm neonates) to set up the normal (control) ranges. The control cord plasma lactate levels and L/P ratios were 2660 [700 (SD)] μmol/l, 16 (3) in full‐term neonates and 2750 (740) μmol/l, 17 (3) in preterm neonates, respectively. We also measured the lactate levels and L/P ratios in the high‐risk full‐term (n= 23) and preterm (n= 35) neonates, the results were 4500 (2600) μmol/l,19(13), and 5100 (2700) μmol/l,26 (12), respectively. With the aid of elevated lactate levels and L/P ratios, the occurrence of neonatal encephalopathy can be predicted with a sensitivity of 100% and a specificity of 94.5% in this patient group. In our study, the six cases with abnormal neurodevelopment at 6–9 months of age all had both elevated lactate levels and L/P ratios at birth. We conclude that the measurement of lactate levels in combination with L/P ratios is a useful quantitative tool in assessing the existence and severity of perinatal hypoxia in the high‐risk neonates.