Clinical outcomes and determinants of intraoperative hyperlactatemia in neonates undergoing gastrointestinal surgery: a retrospective cohort analysis.

BACKGROUND: The clinical significance of hyperlactatemia in neonates undergoing gastrointestinal surgery remains unclear. This study aimed to evaluate the prevalence, clinical outcomes, and associated risk factors of intraoperative hyperlactatemia (IHL) among neonates undergoing gastrointestinal surgery. METHODS: A retrospective cohort analysis was conducted, including neonates who underwent gastrointestinal surgical procedures between May 2020 and October 2022. IHL was defined as a blood lactate concentration exceeding 2.0 mmol/L. The incidence of IHL was determined alongside relevant clinical characteristics and postoperative outcomes. Potential risk factors were explored using univariate analysis followed by multivariable logistic regression. RESULTS: Of the 570 neonates included, 34.6% developed IHL. Neonates with IHL demonstrated significantly higher 30-day mortality (15.2% vs. 2.1%, P<0.001), longer duration of mechanical ventilation (17.6 vs. 12.4 hours, P<0.001), and a greater incidence of postoperative complications, including pulmonary complications (50.3% vs. 38.9%, P=0.009). Multivariable analysis showed that younger age [odds ratio (OR) =0.917; 95% confidence interval (CI): 0.887-0.949], preoperative acidosis (OR =1.619; 95% CI: 1.061-2.470), emergency surgical intervention (OR =4.086; 95% CI: 1.877-8.890), and intraoperative blood transfusion (OR =2.018; 95% CI: 1.221-3.336) were independently associated with IHL. CONCLUSIONS: IHL is frequently observed in neonatal gastrointestinal surgery and is strongly associated with adverse clinical outcomes. Younger age, preoperative acidosis, emergency surgery, and intraoperative blood transfusion were independently associated with the occurrence of IHL.