Positive impact of sodium L-lactate supplementation on blood acid-base status in preterm newborns

Abstract

Preclinical studies indicate that lactate is a crucial cerebral energy substrate, with Na-L-lactate administration significantly reducing brain lesion volumes and improving motor and cognitive functions following neonatal hypoxia-ischemia in rat pups. Its neuroprotective effects are linked to neuronal metabolic utilization, making it a promising candidate for treating newborns with hypoxia-ischemia encephalopathy, a condition where hypothermia remains the only established therapy. However, before initiating a clinical trial, it is necessary to assess the effects of Na-L-lactate infusion on blood parameters. We retrospectively analyzed blood parameters in 60 premature neonates during their first days of life. Among them, 30 received Na-L-lactate instead of Na-Cl to prevent hyperchloremic acidosis. Blood pH, lactatemia, bicarbonates, glycemia, natremia, chloremia, base excess, and hemoglobin were monitored before, during, and after Na-L-lactate infusion. Our findings showed that Na-L-lactate infusion lowered blood lactate levels while increasing pH from 7.25 to 7.31. After stopping the infusion, lactatemia was 1.9 mM, and pH reached 7.32. Na-L-lactate supplementation effectively restored normal blood pH, maintained natremia, and prevented hyperchloremia. Notably, even in cases of high initial lactatemia, lactate levels decreased during the infusion. Our data are promising and emphasize the need for further research to explore its potential applications in neonatal clinical care.