Chilinda et al. BMC Res Notes (2018) 11:477 https://doi.org/10.1186/s13104-018-3598-9 RESEARCH NOTE Point-of-care umbilical arterial lactate and newborn outcomes in a low resource setting: cohort study George Kassim Chilinda 1* , Luis Aaron Gadama 2 and William Stones 3 Abstract Objective: Birth asphyxia contributes substantially to the burden of intrapartum stillbirth and neonatal mortality in resource limited countries. We investigated clinical correlates and neonatal outcomes of lactate analysis of umbilical arterial cord blood in a large referral maternity unit in Malawi using a point-of-care test (Lactate Xpress, Nova Biomedi- cal, Runcorn, UK) and examined maternal and neonatal characteristics and outcomes. Results: There were 389 live births and 12 intrapartum stillbirths during the study. The median umbilical arterial lactate concentration was 3.4 mmol/L (interquartile range 2.6–4.9). Umbilical arterial lactate concentrations among the 45 babies admitted for special neonatal care were above 5 mmol/L in 16/45 (36%) of cases, with no fatality below 13 mmol/L. A positive malaria rapid diagnostic test was associated with hyperlactatemia (p < 0.05). In receiver-opera- tor characteristic (ROC) analysis using a lactate cutoff of 5 mmol/L, areas under the curve were 0.72 (95% CI 0.66–0.79) and 0.64 (95% CI 0.58–0.69) for the Apgar score at 1 and 5 min respectively. This approach can identify safely those newborns that are unlikely to require additional monitoring. Scale-up implementation research in low resource coun- try referral units is needed. The influence of malaria on neonatal hyperlactatemia requires further exploration. Keywords: Birth asphyxia, Fetal distress, Hyperlactatemia, Newborn care, Neonatal death, Malaria © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Introduction Alongside eforts to strengthen maternal and fetal safety through detection of problems in the antenatal period, monitoring during labour and delivery [1], and ensur- ing access to immediate newborn resuscitation where needed, a need has been recognised for tools to support clinical decision making and care. While Apgar scoring remains the mainstay of clinical assessment and has been used extensively in outcome studies, its precision may be limited by the skill and experience of staf. Furthermore, some newborns with signifcant hypoxia and acidaemia may pass unrecognised owing to a normal Apgar score but sufer adverse consequences later such as poor feed- ing, hypoglycaemia, and seizures; by contrast, scores may be low from causes other than birth asphyxia. To improve the diagnosis of birth asphyxia, acid–base analy- sis of umbilical cord blood has been deployed in mater- nity units in high resource countries either for all births or in ‘high risk’ cases according to national guidelines [2]. Umbilical cord lactate estimation is attractive as a simpler alternative to blood gas analysis, using either a hospital chemistry analyser or a point-of-care device. Its validity has been confrmed in a systematic review [3] that also emphasised the need for studies in low- and middle- income countries with a higher burden of newborn com- plications. A point-of-care approach has recently been reported from a middle-income country setting, using lactate as a guide to clinical care and for feedback to clini- cians about the accuracy of their intrapartum monitoring and its interpretation [4]. In our extremely resource-limited maternity service context, we aimed to assess the potential of umbilical arterial lactate analysis using a point-of-care test along- side clinical assessment with Apgar scoring, taking maternal risk factors into account, to identify newborns Open Access BMC Research Notes *Correspondence: gchilinda@gmail.com 1 Department of Obstetrics and Gynaecology (Ethel Mutharika Maternity Wing), Kamuzu Central Hospital, Lilongwe, Malawi Full list of author information is available at the end of the article