Another neonatal encephalopathy predictor fails to pass the test

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Neonatal encephalopathy results in a high incidence of death or neurodevelopmental abnormality. Predictive tests that can reliably identify infants at-risk are needed to identify those infants who would most benefit from newer neuroprotective therapies. Previous reports have found that elevated urinary lactate to creatinine ratios have a good predictive value for the development of hypoxic ischemic encephalopathy and later neurodevelopmental abnormalities. In this issue of The Journal, Oh et al confirmed, in a multicenter trial, that urinary lactate to creatinine ratios were significantly associated with death or moderate/severe neuro-developmental disability. However, there was large variability and considerable overlap of the data between infants with a normal outcome and those with a poor outcome. This makes it highly unlikely that the calculation would be useful as a predictive tool in clinical situations. Better tests will be needed in the future.