The Predictive Value of Elevation in Specific Serum Enzymes for Subsequent Development of Hypoxic-Ischemic Encephalopathy or Intraventricular Hemorrhage in Full-Term and Premature Asphyxiated Newborns

Abstract

Serum lactate dehydrogenase (LDH), aspartate aminotransferase (ASAT), and hydroxybutyrate dehydrogenase (HBDH) activities are significantly elevated in asphyxiated newborns within the first days of life. The approach of the present study was to evaluate firstly if serum levels of these enzymes correlate with the development of hypoxic-ischemic encephalopathy (HIE) and periventricular-intraventricular hemorrhage (PIVH) in full-term and premature asphyxiated newborns, and secondly if postnatally elevated enzyme activities could be predictive for these disorders. ASAT, LDH and HBDH activities were measured in 98 asphyxiated newborns. Blood samples were taken serially at five fixed times: 0 (cord), 12, 24, 72, and 144 hours post partum. All newborns were examined for the development of HIE and PIVH using standardized scoring systems. Fifty percent of the newborns were full-term and 50% were premature. Ten of the full-term (20.4%) and 21 (42.8%) of the premature newborns developed HIE. Nineteen newborns (19.4%) suffered PIVH (full-term/premature, 7/12). The full-term asphyxiated newborns with HIE or PIVH showed significantly elevated ASAT, LDH, and HBDH activities within the first 72 hours of life. In case of the premature asphyxiated newborns, the enzyme activities did not differ significantly between the study groups. The overall predictive values showed a high sensitivity (HIE/PIVH, 90.0%/71.4%), a high specificity (71.0%/88.1%), an acceptable negative predictive value (44.9%/50.0%), and a high positive predictive value (96.5%/94.9%) for the development of HIE and PIVH in full-term asphyxiated newborns. It is concluded that measurements of ASAT, LDH, and HBDH activities are reliable predictors for the development of HIE and PIVH in full-term asphyxiated newborns.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum Enzyme Activities in Premature Infants with Bronchopulmonary Dysplasia

“…This finding that both groups of premature infants, with and without BPD, show early enzyme increase after birth, as compared with the reference values of healthy, term newborns, corresponds to results of previous investigations, where postpartal enzyme elevations are the results of hypoxic-ischemic events, independently of birth weight and gestational age [8,[11][12][13][14]. According to Lackman's group [5][6][7][8], it is known that any secondary hypoxia, due to the development of acute or chronic pulmonary insufficiency, is insignificant in comparison with the primary, perinatal hypoxic-ischemic event. Possibly, interventions aimed at preventing pulmonary damage by reducing ventilatorand oxygen-induced injury or by modifying the resulting inflammatory process, may help to prevent and therefore attenuate the effects of unresolved acute lung disease associated to hypoxia.…”

“…In fact, no previous studies have defined distinct inclusion criteria for acute and chronic respiratory disorders, and performed enzyme measurements serially during and after the neonatal period. Recently, Lackman and co-workers [5][6][7][8] found that AST, LDH and HBDH measurements per-Zanardo/Rizzo/Trevisanuto/Simbi/Golin/ Magarotto/Marzari formed within the first 72 h of life were highly predictive for the development of hypoxia-related neurologic disorders, while they were not significantly altered by the development of RDS.…”

“…In particular, in the case of asphyxiated prematures with RDS, a significant increase in aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and hydroxybutyrate dehydroge- nase (HBDH) activities was demonstrated up to 3 days postpartum. These elevations, directly dependent on a diminished oxygen supply to the fetus during the perinatal period, were correlated with the development of hypoxia-related neurologic disorders in asphyxiated newborns with periventricular hemorrhage [4][5][6][7][8]. Unfortunately, previous studies on enzyme measurement in highrisk premature infants did not define distinct inclusion criteria for respiratory disorders, and were not performed serially after the neonatal period, even if this may be of critical importance to focus neurologic and respiratory sequelae [2,3,9].…”

Value of Myocardial Hypoxia Markers (Creatinine Kinase and Its MB-Fraction, Troponin-T, QT-Intervals) and Serum Creatinine for the Retrospective Diagnosis of Perinatal Asphyxia

“…To estimate prognosis in infants born Möller/Thielsen/Schaible/Reiss/Kohl/ Welp/Gortner with low umbilical pH or Apgar scores, the retrospective evaluation of the degree of organ hypoxia, after the instability during the first days, is important. Markers of organ hypoxia have been found to be significantly increased in asphyxiated infants, and a correlation with high levels of hypoxia markers of different organs and brain damage has been documented for CK and CK-MB [9,11,19], for alanine and aspartate aminotransferase [19,22], neuron-specific enolase [23,24], and creatinine levels [4,9,10]. Especially creatinine, i.e.…”

“…0.05 was considered to be significant (Bonferoni correction). As 0.3 ng/ml troponin T has been shown to indicate myocardial hypoxia in adults [2,9,13,[19][20][21], we examined its positive predictive value in asphyxiated newborns. As it was 1.0 we than searched for the lowest level of troponin T still associated with a positive predictive value for the diagnosis of asphyxia of 1.0 to determine a possible cut-off level.…”