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Lactate dehydrogenase as an indicator of severe illness in neonatal intensive care patients: a longitudinal cohort study


M Karlsson, M.D., Ph.D., Centre for clinical research, Centralsjukhuset i Karlstad, Hus 73, S-651 85 Karlstad, Sweden.
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Aim:  Lactate dehydrogenase (LDH) increases in several critical conditions that cause cell damage and could potentially be used for early detection of serious illness in the newborn. Our aim was to investigate the relationship between the early clinical course of NICU infants and LDH in plasma at admission.

Methods:  LDH was measured in a cohort of patients consecutively admitted to a major NICU in Hanoi. The infants were classified as ‘obviously needing intensive care during the first week’ (n = 83) or ‘not receiving intensive care measures during the first week’ (n = 260) by a senior neonatologist blinded to the LDH and lactate activity.

Results:  LDH differed significantly between the groups in infants born after 32 gestational weeks. LDH differed with the vitality of the patient (F = 26.25, p < 0.0001) at admittance and correlated with lactate (R = 0.496, p < 0.0001). Also, the predictive value for obvious need of intensive care was higher for LDH than for lactate assessed by area under the curve calculated with ROC-curves [0.82 (0.77–0.88) vs. 0.67 (0.60–0.75)].

Conclusion:  There is a strong relationship between bad clinical condition of infants during first week of life and elevated plasma LDH. The results suggest that LDH might be a valuable support in decision making in the neonatal period.