Lactate as a biomarker for discriminating and assessing prognosis of neonatal necrotising enterocolitis: A systematic review and meta-analysis

Abstract

Background and Objective: Neonatal necrotising enterocolitis (NEC) is a severe neonatal gastrointestinal disease associated with high morbidity and mortality. The present systematic review and meta-analysis examined if blood lactate could be used in the diagnosis and prognosis of NEC.

Methodology: PubMed, Embase, Scopus, and Web of Science databases were searched for relevant studies from the database inception to 18 January 2026. Diagnostic studies comparing lactate levels between NEC and control groups were pooled using standardised mean differences (SMDs). Prognostic studies evaluating mortality were pooled using odds ratios (ORs) under a random-effects model.

Results: Nine studies were included, comprising four diagnostic and five prognostic studies. Lactate levels were significantly higher in neonates with NEC compared with controls (SMD = 1.66, 95% CI 0.78–2.55 I² = 93%). In prognostic analyses, higher lactate levels were associated with an increased risk of mortality, but the pooled effect did not reach statistical significance (OR = 1.30, 95% CI 0.92–1.83; I² = 75.8%). In the sensitivity analysis, excluding one study led to a statistically significant association between higher lactate levels and NEC mortality.

Conclusions: This review suggests that lactate levels are significantly higher in neonates with NEC as compared with controls. However, while elevated lactate tends to be associated with increased mortality risk, substantial heterogeneity and limited evidence preclude its use as a standalone prognostic marker. Further research is needed to strengthen the present conclusions.