Serum lactate as mortality and morbidity marker in infants after Jatene's operation

OBJECTIVE

To assess the morbidity and mortality after Jatene's operation using lactate as the main marker.

METHODS

We performed a historical cohort with infants admitted in a pediatric intensive care unit during 1995 to 2005 who underwent this surgery. We assessed the preoperative, immediate (IPD), third hour (3h), six hour (6h) and first day (POD1) serum lactate as well as other factors such as sepsis, increased bleeding, low cardiac output syndrome, renal insufficiency, pulmonary hypertension, cardiac arrythmias, chylothorax, myocardial ischemia, seizures, presence of other complication, and also information about length of PICU stay and death.

RESULTS

The mean age of 76 patients was 14.59± 19.09 days, birth weight 3.128± 0.48 kg Forty-four patients had the diagnosis of simple transposition of great arteries. The circulatory bypass time was 143.78± 28.77 minutes and aortic clamping time of 87.68± 22.3 minutes and LOS of 20.28 ± 15.62 days. Twenty four (31.58%) died during hospital stay. Lactate increased in IPD, returning to baseline at 24 hours. Patients who died raised and maintained IPD lactate higher. The 3h lactate best discriminated mortality with area under the curve of 0.68 (CI 0.54 to 0.83) P = 0.035. However, considering a cutoff point for lactate greater or equal to 5.8 mmol/dl in the 3-h PO, we obtained only 67% sensitivity and specificity of 64% for mortality. There is positive correlation between number of complications and lactate. The low cardiac output syndrome with an odds ratio (OR) of 7.67 (2.38-24), increased bleeding with OR 2.91 (1.07-7.94) and respiratory complication with OR 1.67 (1.35-2.05) are risk factors when combined.

CONCLUSION

After Jatene's operation, morbidity and mortality can be assessed with the serum lactate levels, suggesting increased values in the third hour is suggestive of a worse prognosis.

[The influence of intrapartum antibiotic therapy on the diagnosis of early-onset neonatal sepsis]

OBJECTIVE

To determine the influence of intrapartum antibiotic therapy on blood and secretion cultures of newborn infants suspected of early-onset sepsis.

MATERIAL AND METHODS

From August 1995 through July 1996, 69 sequential newborn infants with early-onset sepsis or septic syndrome were included in the study. All of them were followed for the end point: positivity of blood, urine, CSF, tracheal secretion or umbilical catheter cultures. The sample size was figured out to be 17 for each group, for a significant level of 5%.

RESULTS

Seventeen mothers were treated with antibiotic. Ampicillin alone or in association with other drugs was utilized in 70% of them. Urinary tract infection occurred in 9 mothers (53%), ammonites in 6, one mother had both and another one had erysipelas. Thirteen newborn infants had positive cultures in the group whose the mothers had not received antibiotic (n=52), none of the 17 newborn infants delivered by the mothers treated with antibiotic had any positive culture (p=0.0164). The relative risk of positive culture in a septic neonate if the mother is not treated with antibiotic is 12 times higher than if the mother is treated with antibiotic.

CONCLUSION

The use of intrapartum antibiotic in newborn infants with early-onset sepsis or septic syndrome may cause a negativity of cultural exams, increasing the difficulty of the diagnosis of early-onset neonatal sepsis.