EARLY BIOCHEMICAL PREDICTORS OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY AFTER PERINATAL ASPHYXIA | ||||
| Al-Azhar Journal of Pediatrics | ||||
| Article 6, Volume 24, Issue 3, July 2021, Page 2248-2266 PDF (286.54 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/azjp.2021.210116 | ||||
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| Abstract | ||||
| Background: Hypoxic-ischemic encephalopathy (HIE) is a common and serious disease of newborns leading to long term consequences. Objectives: To investigate the possibility of using blood Lactate Dehydrogenase (LDH), Creatine Kinase muscle-brain and brain fractions (CK-MB, CK-BB) and Serum lactate levels as an early predictors for neonatal HIE and its severity even before the appearance of full clinical features to initiate early proper management. Patients and Methods: A prospective case control study conducted on newborn infants admitted to the neonatal intensive care unit of Military Hospital–Wadi Aldawasir-KSA from January 2016 to January 2018. Thirty full term patients were enrolled to the study with documented perinatal asphyxia in addition to twenty full-term healthy newborn infants with no signs of birth asphyxia and an uneventful course during pregnancy and postnatal life as a control group. Full history taking, thourough clinical examination and routine laboratory tests in addition to biochemical markers (LDH, CK-MB, CK- BB and Serum lactate) were taken from all the babies within 15 min, then at 24 hrs. and 48 hrs. after birth. RESULTS: The mean CK-MB level was 84.021 ± 39.24 U/L in asphyxiated group and 37.094 ± 14.76 U/L in the control group, with a statistically significant difference and P value <0.001, while the mean LDH value was (867.69 ± 372.61 U/L and 348.72 ± 112.61 U/L in both groups respectively) with a statistically significant difference and P value <0.001. A similar statistically significant difference found between both groups regarding Mean CK-BB and Serum Lactate. Among the asphyxiated group, the cut-off CK-MB value of (>90.4 U/L) had sensitivity of (27.3 %), specificity of (99%), positive predictive value of (99%) and negative predictive value of (59.4%), while the cut-off LDH value of (>540 U/L) has (90.24%) sensitivity, (93.89%) specificity, (90.36%) positive predictive value and (94.32%) negative predictive value. The predictive values of these biochemical markers in determining neonatal HIE and stages of severity were assessed. Conclusion: LDH, CK-MB, CK-BB and Serum Lactate are useful biomarkers for early detection of HIE and if done routinely at the first few hours after birth for clinically suspected cases - even before appearance of full clinical signs - it will lead to early detection and initiation of managment aiming to improve the outcome. LDH is more sensitive but less specific biomarker while CK-MB has higher specificity and lesser sensitivity for perinatal hypoxic brain injury. The diagnostic performance of LDH seemed to be better than CK-MB in the newborns with perinatal asphyxia. | ||||
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