Urinary uric acid to creatinine ratio as a marker of perinatal asphyxia and its correlation with arterial blood gas values

Objective Perinatal asphyxia is a leading cause of neonatal morbidity and mortality in developing countries. Lack of facilities like arterial blood gas analysis in resource limited settings warrants cost effective methods to support the diagnosis of asphyxia. The study objectives were to evaluate the utility of urinary uric acid to creatinine ratio (UA/Cr ratio) as a marker of perinatal asphyxia and to ascertain its correlation with cord blood arterial blood gas values. Methods It was a prospective comparative study where cases and controls were of asphyxiated neonates and normal neonates respectively delivered in a tertiary care medical college hospital from April 2019 to September 2019. Urinary UA/Cr ratio and its correlation with Apgar score was determined. The ability to predict asphyxia was estimated by ROC curve and p<0.05 was considered as statistically significant. Results Data from 38 asphyxiated and 38 normal neonates were analyzed. The mean urinary UA/Cr ratio was higher in the asphyxiated babies. There was negative correlation between urinary UA/Cr ratio and pH, pO2, Apgar scores and positive correlation with pCO2. The urinary UA/Cr ratio had excellent predictive validity for perinatal asphyxia determined by ROC curve. The urinary uric acid /creatinine ratio had sensitivity of 92.11% and specificity was 92.11%. Conclusion Urinary uric acid to creatinine ratio correlated well with the cord blood arterial blood gas values and the Apgar scores. This study showed that there is a significant increase in the urinary UA/Cr ratio in asphyxiated neonates and it can be used as a biochemical marker of perinatal asphyxia.

Near-Infrared Spectroscopy Monitoring of Cerebral Oxygenation and Influencing Factors in Neonates from High-Altitude Areas

<b><i>Background:</i></b> Accurate detection of cerebral oxygen saturation (rSO₂) may be useful for neonatal brain injury prevention, and the normal range of rSO₂ of neonates at high altitude remained unclear. <b><i>Objective:</i></b> To compare cerebral rSO₂ and cerebral fractional tissue oxygen extraction (cFTOE) at high-altitude and low-altitude areas in healthy neonates and neonates with underlying diseases. <b><i>Methods:</i></b> 515 neonates from low-altitude areas and 151 from Tibet were enrolled. These neonates were assigned into the normal group, hypoxic-ischemic encephalopathy (HIE) group, and other diseases group. Near-infrared spectroscopy was used to measure rSO₂ in neonates within 24 h after admission. The differences of rSO₂, pulse oxygen saturation (SpO₂), and cFTOE levels were compared between neonates from low- and high-altitude areas. <b><i>Results:</i></b> (1) The mean rSO₂ and cFTOE levels in normal neonates from Tibet were 55.0 ± 6.4% and 32.6 ± 8.5%, significantly lower than those from low-altitude areas (<i>p</i> &#x3c; 0.05). (2) At high altitude, neonates with HIE, pneumonia (<i>p</i> &#x3c; 0.05), anemia, and congenital heart disease (<i>p</i> &#x3c; 0.05) have higher cFTOE than healthy neonates. (3) Compared with HIE neonates from plain areas, neonates with HIE at higher altitude had lower cFTOE (<i>p</i> &#x3c; 0.05), while neonates with heart disease in plateau areas had higher cFTOE than those in plain areas (<i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> The rSO₂ and cFTOE levels in normal neonates from high-altitude areas are lower than neonates from the low-altitude areas. Lower cFTOE is possibly because of an increase in blood flow to the brain, and this may be adversely affected by disease states which may increase the risk of brain injury.

Common Neonatal Presentations

Parents of newborns, particularly first-time parents, are often concerned that their infant has a physical examination finding or behavior that is out of range of normal. Neonates have a variety of common findings and diagnoses specific to this age group. However, their range of behaviors is limited, and they are unable to communicate, complicating evaluation. Caring for neonates in the emergency department requires knowledge of newborn-specific conditions as well as the range of normal behaviors. Common chief complaints include jaundice, feeding difficulties, vomiting, irritability and crying, breathing difficulty, and rash. Emergency department providers must be familiar with the range of normal behaviors and common diagnoses seen in neonates. This chapter presents an overview of common concerns parents have about their neonates.

Study of Cord Blood Erythropoietin, Leptin and Adiponectin Levels in Neonates with Hypoxic Ischemic Encephalopathy

Background: Hypoxic ischemic encephalopathy (HIE) is a serious condition which results in neonatal morbidity and mortality. Early prediction of HIE especially in the first six hours of birth leads to early treatment with better prognosis. Aim: The aim of this study was to compare the concentrations of leptin, adiponectin, and erythropoietin between normal neonates and those with HIE for the possible use of these markers for assessment of the degree of HIE and as markers for early prediction of HIE. Patients and Methods: This study was carried out on 50 appropriate for gestational age (AGA) neonates with HIE born in Tanta University Hospital during the period from June 2016 to March 2018 (Group I). This study also included 50 appropriate for gestational age (AGA) normal neonates not suffering from any complications and matched with group I in age and sex as a control group (Group II). For all neonates in both groups, the following were done: Complete prenatal, natal, and postnatal history, assessment of APGAR score at 5 and 10 minutes, complete clinical examination with special account on clinical evidence of encephalopathy including hypotonia, abnormal oculomotor or pupillary movements, weak or absent suckling, apnea, hyperpnea, or seizures, measurement of cord blood gases and measurement of serum erythropoietin, leptin and adiponectin levels by ELISA immediately after birth. Results: There were no significant differences between Group I and Group II regarding gestational age, male to female ratio, mode of delivery, and weight while there were significant differences regarding Apgar score at 1 and 5 minutes with significantly lower Apgar score at 1 and 5 minutes in group I compared with Group II. There were significantly lower cord blood PH and adiponectin level and significantly higher cord blood Leptin and erythropoietin in group I compared with group II. There were significant differences between cord blood adiponectin, leptin, erythropoietin, and PH in different degrees of HIE with significantly lower cord blood adiponectin and PH and significantly higher cord blood leptin and erythropoietin in severe degree of hypoxia compared with moderate degree and in moderate degree compared with mild degree of hypoxia. There was a significant positive correlation between cord blood erythropoietin and leptin and a significant negative correlation between cord blood erythropoietin and both adiponectin and PH in studied neonates with hypoxia. ROC curve showed that EPO had the best sensitivity and specificity followed by leptin then adiponectin while the PH had the least sensitivity and specificity as early predictors of hypoxic neonates. Conclusion and Recommendations: Neonates with HIE had lower cord blood PH and adiponectin levels and higher leptin and erythropoietin levels than normal healthy neonates at birth and during the early postnatal period. The significant differences between cord blood erythropoietin, leptin, and adiponectin between neonates with hypoxia compared with normal neonates may arouse our attention about the use of these markers in the cord blood as early predictors of neonatal HIE which can lead early treatment and subsequently better prognosis.

Correlation of Serum LDH Level in Perinatal Ashyxia as a Marker of Hypoxic Ischemic Encephalopathy

Introduction: Perinatal Asphyxia is common cause of multiorgan dysfunction in neonates. It leads to significant mortality and morbidity. Serum lactate dehydrogenase (LDH), if measured can differentiate asphyxiated neonates from non-asphyxiated neonates. Objectives: To find whether serum LDH can distinguish an asphyxiated from a non-asphyxiated term neonate. To co-relate serum LDH level in perinatal asphyxia with various stages of HIE and to see whether it can predict mortality. Methodology: This is a prospective study done from June 2018 to May 2019 in NICU of Nobel Medical College, on child with Perinatal Asphyxia. All neonates included in the study underwent thorough clinical and neurological examination. Severity of HIE was done by Sarnat & Sarnat staging criteria. Serum LDH level were measured in all the cases. Statistical analysis was done using SPSS 11. Results: 90 neonates with perinatal asphyxia were enrolled and 30 normal neonates were enrolled as controls. The number of neonates with LDH level > 600U/L was significantly more in cases with perinatal asphyxia group as compared to controls (non-asphyxiated) with ‘p’ < 0.001. Serum LDH level was progressively high in relation to stages of HIE and difference between mean LDH level between neonates expired and survived was statistically significant with ‘p’ <0.001. Conclusion: Serum LDH level is a reliable indicator of perinatal asphyxia and helps to differentiate different stages of HIE.

Pyridinium Crosslinks (Pyd) in the Urine is Associated with Stunting in Neonates

Aims: The aim of the research is to evaluate the reliability of bone resorption biomarkers called Pyridinium Crosslinks (Pyd) in the urine of the neonates as an evaluation to bone growth of the neonate, as an indicator of stunting. Study Design: A cross-sectional study. Place and Duration of Study: Andini Mothers and Children Hospital (Pekanbaru, Indonesia). Duration of the study was between, August until September 2014. Methodology: Subjects of study were 35 healthy neonates. Subjects were recruited at the first 3 days of life. Body length gauges, digital weighting scale, family socioeconomic questionnaires and Pyd kit were used to collect the data. Differences in the mean of the research variables were tested using an Independent t-test. Results: Results showed that there were significant differences (p<0.01) in terms of height for age and Pyd in the urine of stunted (body length <48 cm) versus normal (body length ≥48 cm) neonates. The contents of Pyd in the urine of stunted neonates were 982.9±61.6 and normal neonates was 594.1±266.1 nmol/mmol. Conclusion: Therefore, there is a possible association between height for age and Pyd in the urine as a potential early indicators to identify stunted and normal neonates.

Differences in Brain-Derived Neurotrophic Factor and Matrix Metalloproteinase-9 between Appropriate Neonates between Normal Birth Weight and Intrauterine Growth Restriction

BACKGROUND: Intrauterine Growth Restriction (IUGR) was defined as the growth of the fetus less than its normal potential growth due to genetic and environmental factors. One of the most widely believed causes of IUGR was impaired uteroplacental mechanism from mother to fetus. Furthermore, factor which was thought to affect placental growth was due to the influence of Brain-Derived Neurotrophic Factor (BDNF) and Matrix Metalloproteinase (MMP-9) which play an important role in angiogenesis. AIM: This study aims to determine differences in Brain-Derived Neurotrophic Factor (BDNF) and moderately mature Matrix Metalloproteinase (MMP-9) between normal birth weight and intrauterine growth restriction. MATERIAL AND METHODS: The study design was a cross-sectional study at four hospitals in Padang city from August 2017-January 2018. The sample of this study was umbilical cord blood of appropriate gestational age neonate with normal birth weight (31 neonates) and IUGR (31 neonates) by consecutive sampling, samples taken from mothers who meet inclusion criteria. BDNF and MMP-9 levels were analysed by ELISA. The differences between normal birth weight and IUGR test were followed by unpaired T-test. RESULTS: The results showed that BDNF levels in normal neonates was 1.58 ± 0.23 ng/ml and in IUGR neonates were 1.25 ± 0.35 ng/ml (p = 0.001). MMP-9 levels in normal neonates was 1.09 ± 0.20 ng/ml and in IUGR neonates were 1.25 ± 0.35 (p = 0.03). CONCLUSION: The conclusion of this study was BDNF of moderately mature neonates was significantly higher in normal birth weight compared to intrauterine growth restriction, and the moderately high MMP-9 neonates were significantly higher in intrauterine growth restriction compared with normal birth weight.

Differences of Zinc and Copper Levels In Placenta Blood Normal Neonates and Intrauterine Growth Restriction

Zink and copper are the micronutrients which play a role in the growth and development of fetal and infant. Its deficiency in pregnant women shall give a birth the restriction fetal growth 16,11. This research is proposed to distinguish zinc and copper levels in normal neonates and those restriction fetal growth.The research was conducted with a comparative cross sectional analysis, experienced by three hospitals those are TK III Reksodiwirjo Hospital, Dr. Rasidin Hospital, and Bayangkara Hospital in the city of Padang. It also conducted in the SMAK Padang Chemistry Laboratory in November 2016 - January 2018. The research sample was taken from newborn blood centers for 60 respondents by consecutive sampling. Zinc and copper levels were examined by Atomic Absorption Spectrophotometry (AAS). Hypothesis testing was done by unpaired t testing.The results showed the average zinc level in restriction fetal growth group was 89.34 ± 31.53 µg / dL and normal neonates were 122.703 ± 39.3 µg / dL with p = 0.01. The mean copper content in the restriction fetal growth group was 0.5142 ± 0.15 µg / dL and the normal neonate was 0.6892 ± 0.17 µg / dL with p <0.01The conclusion of this research is zinc and copper levels in normal neonates were significantly higher than neonatal zinc and copper levels restriction fetal growth.

Comparison of gestational age assessment by new ballard score and parkin score in neonates

Background: In newborn, both normal and sick, gestational age (GA) is important to evaluate the risks of morbidity and mortality and may modify the line of management. The objective of the present study was to compare the New Ballard Score (NBS) and Parkin’s score in estimating GA among normal neonates, sick neonates.Methods: Observational analytical study of 500 neonates, who qualified the selection criteria. GA estimated by Naegele’s rule (G-LMP), NBS and Parkin score. Data collected and analysed by SPSS 21.Results: The mean gestational age as estimated by last menstrual period was 37.7 weeks; NBS- 37.66 weeks, Parkin score-37.7 weeks. Mean difference between the two scores estimating GA in all neonates was 3.75 days, in normal neonates- 3.61 days, sick neonates-3.7 days. NBS and Parkin score were calculated in both groups, had strong positive correlation (p value <0.05) with G-LMP. GA calculated using NBS and Parkin score had a strong positive correlation (p value <0.05). in all sick neonates except HIE-3 and RDS, NBS had significant correlation with G-LMP, but Parkin score had significant correlation with all. The mean difference between the two scores with RDS and HIE-3 was 11.64 days. Total crying episodes in NBS were 334 and Parkin score were 124. Mean time taken to complete NBS was 5 min 33 sec and Parkin score was 1 min 36 sec.Conclusions: GA of sick neonates with HIE-3 and RDS were better assessed by Parkin score. Parkin score caused less discomfort to neonates.