Early Lactate Clearance and Mortality Risk in Neonatal Sepsis: A Systematic Review

Abstract

Introduction: Neonatal sepsis remains an important cause of neonatal mortality, highlighting the need for accessible prognostic biomarkers. Early lactate clearance has been proposed as a potential indicator of adverse clinical outcomes. Objective: To evaluate the prognostic relevance of early lactate clearance for mortality in neonatal sepsis while considering complementary evidence from related lactate-based measurements. Methods: A systematic review was conducted using PubMed, Cochrane Library, and ScienceDirect. Five observational studies evaluating lactate clearance, serial lactate changes, or absolute lactate concentrations in neonatal populations were synthesized qualitatively. Risk of bias was assessed using the Newcastle–Ottawa Scale. Result and Discussion: Five observational studies involving 993 neonates found that reduced six-hour lactate clearance was associated with increased mortality in neonatal sepsis, but heterogeneity in populations and measurement approaches prevented pooling, suggesting lactate measurements may offer prognostic value despite limited strength due to observational designs and confounding. Conclusion: Early lactate clearance shows potential as a complementary prognostic marker in neonatal sepsis. Further prospective studies are needed to establish standardized measurement intervals, prognostic thresholds, and clinical applicability