# Investigation of the relationship between blood lactate levels and neonatal hyperbilirubinemia: A predictive approach to assessing severity on NHB in neonates

## TL;DR

This study explores if blood lactate levels can predict the severity of neonatal hyperbilirubinemia more accurately than traditional bilirubin measurements.

## Contribution

The study introduces blood lactate as a potential novel biomarker for assessing neonatal hyperbilirubinemia severity.

## Key findings

- Blood lactate levels are positively correlated with total bilirubin levels in neonates with NHB.
- Blood lactate shows higher predictive accuracy for NHB severity compared to total bilirubin alone.

## Abstract

Neonatal hyperbilirubinemia (NHB) severity is traditionally assessed using serum total bilirubin levels alone; however, bilirubin measurement can be influenced by multiple physiological factors, limiting its accuracy. This study aimed to explore the correlation between blood lactate levels and NHB and evaluate whether blood lactate could serve as a novel, objective biomarker for predicting the severity and associated organ dysfunction in neonates with NHB.

A total of 123 children diagnosed with NHB and admitted to the obstetrics department from October 2021 to October 2022 were selected as the NHB group, and according to the severity of the disease, they were divided into mild, moderate, and severe. Fifty healthy neonates born in the department of obstetrics were selected as the control group. The levels of glucose-6-phosphate dehydrogenase (G6PD), creatine kinase isoenzyme (CK-MB), p2-microglobulin (P2-MG), aspartate aminotransferase (AST), blood lactic acid and total bilirubin in serum were compared. Pearson correlation analysis was used to analyse the correlation between blood lactate level and bilirubin level, and the ROC curve was used to determine the predictive value of blood lactate level for the severity of NHB in neonates.

The NHB group had significantly higher levels of AST, CK-MB, p2-MG, blood lactic acid, and total bilirubin than the NHB group (P< 0.05). The G6PD level was significantly lower (P < 0 .0 5 ). Pearson correlation analysis showed a positive correlation between blood lactate and total bilirubin levels (r= 0.604, P< 0.001). ROC curve analysis indicated that blood lactate had superior predictive accuracy (AU C= 0.873, sensitivity = 81.3% , specificity = 86.0%) for assessing NHB severity compared to total bilirubin alone (AU C= 0.759, sensitivity = 86.2% , specificity = 82.0% ; P<0.05).

Neonates with NHB have higher serum levels of AST, CK-MB, p2-MG, blood lactate, and total bilirubin, while lower G6PD levels. The serum level of blood lactate is positively correlated with the total bilirubin level, which can be used to observe the severity of NHB in neonates.