Neonatal lactate elevation is a relatively common finding with heterogeneous causes. Understanding the reason for the lactate elevation is critical to determining the prognosis and treatment options. Lactate can be elevated spuriously, secondary to a number of common neonatal conditions or intermediary inborn errors of metabolism, or as a primary finding in mitochondrial diseases. The extent of the lactate elevation, clinical context, and simple metabolic tests can help differentiate among these causes.

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