Measurement of the Urinary Lactate:Creatinine Ratio for the Early Identification of Newborn Infants at Risk for Hypoxic–Ischemic Encephalopathy

Huang, Chao; Wang, Shan Tair; Chang, Ying; Lin, Kung Ping; Wu, Pei Lin

doi:10.1056/nejm199907293410504

Cited by 117 publications

(71 citation statements)

References 30 publications

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“…S100β protein concentrations in moderately/severely asphyxiated neonates were significantly higher than in controls and mildly asphyxiated infants. Huang et al [13] reported that the urinary lactate:creatine ratio predicts HIE within 6 h with 1 H nuclear magnetic resonance spectroscopy, but magnetic resonance spectroscopy is not practical in most clinical situations; a useful indicator for HIE should be specific even earlier, and requires a rapid and readily available laboratory technique. Besides this, infants with asphyxia often have oliguria, and urine sampling may not be possible [19].…”

Section: Discussionmentioning

confidence: 99%

“…The asphyxia group consisted of 40 subsequently full-term newborn infants (gestational age, 37-42 weeks) who fulfilled at least three of the following conditions: fetal bradycardia with a heart rate of less than 100 beats per minute, late decelerations, or an absence of heart-rate variability; thick, meconium-stained amniotic fluid; an Apgar score of 6 or less at 5 min; a need for resuscitation for more than 1 min with positive-pressure ventilation and oxygen immediately after birth [13]. The exclusion criteria were maternal drug addiction, congenital infections, or perinatal infection, including chorioamnionitis.…”

Section: Asphyxia Groupmentioning

confidence: 99%

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Umbilical artery blood S100β protein: a tool for the early identification of neonatal hypoxic-ischemic encephalopathy

2008

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Neuroprotective interventions in neonatal hypoxic-ischemic encephalopathy (HIE) require early indicators of brain damage to initiate therapy. In order to find a reliable, rapid, and simple method to identify infants at risk for this disorder, 40 infants with asphyxia were selected as the observation group (HIE group) and 25 normal-term infants as the control group. S100beta protein concentration and gas analysis of the umbilical cord artery blood of all infants were determined. We found that the S100beta protein levels of the HIE group (1.98 microg/L) were higher than those of the control group (1.05 microg/L, p<0.05), and there were significant differences between the mild HIE group (1.72 microg/L) and the moderate or severe HIE groups (3.61 microg/L, p<0.05). An S100beta protein concentration cutoff level of 2.02 microg/L had a sensitivity of 86.7% and a specificity of 88.0% for predicting the development of moderate or severe HIE. The blood gas parameters of umbilical artery blood, such as pH, carbon dioxide tension, and base excess, were significantly different in the HIE group compared to the control group (all p<0.001), but there were no differences between the mild HIE group and the moderate or severe HIE groups. On the basis of clinical manifestations of asphyxiated neonates, detecting the S100beta protein levels in the umbilical artery blood may be of important value in the early diagnosis and grading of HIE.

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Section: Discussionmentioning

confidence: 99%

Section: Asphyxia Groupmentioning

confidence: 99%

Umbilical artery blood S100β protein: a tool for the early identification of neonatal hypoxic-ischemic encephalopathy

2008

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“…The following study groups were enrolled: (1) neonatal controls: serum samples from term healthy control infants following normal delivery with normal Apgar scores, neurological examination and postnatal course, and (2) infants exposed to perinatal asphyxia (PA): infants with at least 2 of the following criteria were eligible for inclusion according to the criteria of Huang et al [5]: (i) evidence or suspicion of hypoxic-ischaemic injury based on a history of foetal distress, i.e. type II dips, loss of beat-to-beat variability on the cardiotocograph and/or abnormal scalp pH; (ii) need for resuscitation after birth, i.e.…”

Section: Methodsmentioning

confidence: 99%

Perinatal Asphyxia and Erythropoietin and VEGF: Serial Serum and Cerebrospinal Fluid Responses

Sweetman

Onwuneme²,

Watson³

et al. 2016

Neonatology

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Background: Infants with neonatal encephalopathy (NE) of hypoxic-ischaemic origin are at risk of oxidative and ischaemia-reperfusion injury, which may induce abnormal inflammatory responses involving excessive cytokine production and release in serum and cerebrospinal fluid (CSF). Systemic inflammation is found in infants with NE, and we therefore were interested in cytokines associated with hypoxia, including vascular endothelial growth factor (VEGF) and erythropoietin (Epo). Objective: To investigate the relationship between Epo, VEGF levels, brain injury and outcome in a group of term infants exposed to perinatal asphyxia (PA) compared to controls. Methods: Serum and CSF biomarkers associated with hypoxia (VEGF, Epo) were serially measured using multiplex immunoassays over days 1-4 in term infants exposed to PA including infants with NE and controls. Results were compared to severity of encephalopathy, MR brain imaging and mortality. Results: Ninety-four infants had 247 serum samples collected (n = 12 controls, 82 exposed to PA with 34 CSF samples), and 4 infants died. Controls had significantly lower serum Epo levels on days 1 and 2 compared to those exposed to PA (p = 0.02). Grade II/III NE was significantly associated with elevated day 2 Epo and decreased day 1 VEGF (p < 0.05; day 2 Epo AUC = 0.74, cut-off 10.05 IU/ml). Elevated serum Epo was associated with severely abnormal MRI. Mortality was associated with elevated day 3 Epo and decreased day 1 VEGF. CSF levels were all after hypothermia and were not significantly associated with outcome. Conclusion: Serum Epo and VEGF may be markers of severity of hypoxia-ischaemia and brain injury as they are closely related to hypoxic exposure.

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“…Huang et al [56] measured urinary lactate/creatinine ratios in asphyxiated infants soon after birth, using proton nuclear magnetic resonance. 1H nuclear magnetic resonance (NMR) spectroscopy indicated an elevated ratio within 6 hours after birth, with a sensitivity of 94% and a specificity of 100% in predicting HIE.…”

Section: Other Biochemical Markers Of Perinatal Asphyxiamentioning

confidence: 99%

Perinatal asphyxia: Timing and mechanisms of injury in neonatal encephalopathy

Scher

2001

Curr Neurol Neurosci Rep

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This article summarizes the recent medical literature regarding perinatal asphyxia with respect to timing and mechanisms of injury for neonates who were clinically diagnosed with an encephalopathy in the newborn period. Multiple mechanisms of injury are reviewed, including genetic vulnerability, acquired inflammatory responses, and clotting defects that can lead to ischemic-induced brain damage. Before effective treatments for fetal and neonatal brain disorders can be developed, accurate and timely diagnoses of fetal or neonatal brain injury must be achieved. Specific subsets of children can then benefit from neuroprotective strategies that can target the specific developmental aspects of brain adaptation or plasticity relative to the specific etiology and timing of injury after asphyxia.

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Measurement of the Urinary Lactate:Creatinine Ratio for the Early Identification of Newborn Infants at Risk for Hypoxic–Ischemic Encephalopathy

Abstract: Measurement of the urinary lactate: creatinine ratio soon after birth may help identify infants at high risk for hypoxic-ischemic encephalopathy.

Cited by 117 publications

References 30 publications

Umbilical artery blood S100β protein: a tool for the early identification of neonatal hypoxic-ischemic encephalopathy

Umbilical artery blood S100β protein: a tool for the early identification of neonatal hypoxic-ischemic encephalopathy

Perinatal Asphyxia and Erythropoietin and VEGF: Serial Serum and Cerebrospinal Fluid Responses

Perinatal asphyxia: Timing and mechanisms of injury in neonatal encephalopathy

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