Serum Liver Enzyme Pattern in Birth Asphyxia Associated Liver Injury

Abstract

PurposeTo study temporal pattern of serum liver enzymes levels in newborns with hepatic injury associated with birth asphyxia (BA).MethodsSingleton term newborns with BA and ≤72 hours of age admitted to neonatal intensive care unit were prospectively enrolled. Term newborns with physiological jaundice and without BA were studied as controls. Serum liver enzymes were measured at <24 hours, 24-72 hours, and at 6-12 days of age for cases and at 1-6 days of age for controls. BA was defined by 1 minute Apgar score <7 or delayed or absent cry with hypoxic ischemic encephalopathy. BA-associated liver injury was defined as serum alanine aminotransferase (ALT) elevation beyond +2 standard deviation (ALT > +2 SD) above the mean of control subjects at any of the three time points.ResultsSixty controls and 62 cases were enrolled. Thirty-five cases (56%) developed BA-associated liver injury (ALT>81 IU/L). They had higher serum levels of ALT, aspartate aminotransferase, lactate dehydrogenase than the control infants, with peak at 24-72 hours. In controls, serum liver enzyme levels were significantly higher in appropriate-for-date (AFD) babies than small-for-date (SFD) babies. Serum enzyme pattern and extent of elevation were comparable between SFD and AFD babies. Degree of serum liver enzyme elevation had no relationship with severity of hypoxic encephalopathy.ConclusionSerum liver enzyme elevation is common in BA; it peaks at 24-72 hours followed by a sharp decline by 6-12 days of age. Pattern and extent of enzyme elevation are comparable between SFD and AFD babies.

Prediction of Drug Exposure in Critically Ill Encephalopathic Neonates Treated With Therapeutic Hypothermia Based on a Pooled Population Pharmacokinetic Analysis of Seven Drugs and Five Metabolites

“…During the hypoxic-ischemic event, both the kidneys and liver are deprived of oxygen, resulting in possible functional nephron and hepatocyte damage. [23][24][25][26][27] Additionally, cardiac output might also be hampered due to a loss in myocardial function. 28 After resuscitation and stabilization at the NICU, gradual recovery of organ function after birth was anticipated.…”

Early Biochemical Markers of Hypoxic Ischemic Encephalopathy in Neonates

“…A total of fifty seven patients (group A) were enrolled in this study, forty three males (43), and fourteen females (14). Their birth weights ranges from 1.35 kg to 4.77 kg, twenty six were delivered normally (45.6%), fourteen were delivered by caesarean section (24.5%), and seventeen patients were delivered by vacuum delivery (29.8%).…”

“…This is similar to various different studies showed the same results. (11)(12)(13)(14)(15)(16)(17) Many reports suggested that elevation of these biochemical markers especially LDH, is going parallel with the severity of the asphyxia. The greater the degree of the asphyxia, the greater the value of the enzymes elevation.…”

“…Such result is not unique to our study, some other studies showed similar pattern of involvement. (14,15) Regarding brain imaging , it is well-known that brain MRI is the best tool for evaluating hypoxic patients especially between 4 th and 8 th day after hypoxia. Brain ultrasound is not satisfactory and its specificity in children is unacceptably low.…”

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