Measurement of the urinary lactate:creatinine ratio for the early identification of newborn infants at risk for hypoxic-ischemic encephalopathy

Background: Newborn infants with perinatal asphyxia are prone to the development of hypoxicischemic encephalopathy. There are no reliable methods for identifying infants at risk for this disorder. Methods: We measured the ratio of lactate to creatinine in urine by proton nuclear magnetic resonance spectroscopy within 6 hours and again 48 to 72 hours after birth in 58 normal infants and 40 infants with asphyxia. The results were correlated with the subsequent presence or absence of hypoxic-ischemic encephalopathy. Results: Hypoxic-ischemic encephalopathy did not develop in any of the normal newborns but did develop in 16 of the 40 newborns with asphyxia. Within six hours after birth, the mean (±SD) ratio of urinary lactate to creatinine was 16.76±27.38 in the infants who subsequently had hypoxic-ischemic encephalopathy, as compared with 0.09±0.02 in the normal infants (P<0.001) and 0.19±0.12 in the infants with asphyxia in whom hypoxic-ischemic encephalopathy did not develop (P<0.001). A ratio of 0.64 or higher within six hours after birth had a sensitivity of 94 percent and a specificity of 100 percent for predicting the development of hypoxic-ischemic encephalopathy. The sensitivity and specificity of measurements obtained 48 to 72 hours after birth were much lower. The mean ratio of urinary lactate to creatinine was significantly higher in the infants who had adverse outcomes at one year (25.36±32.02) than in the infants with favorable outcomes (0.63±1.50) (P<0.001). Conclusions: Measurement of the urinary lactate:creatinine ratio soon after birth may help identify infants at high risk for hypoxic-ischemic encephalopathy.