Alteration of Hepatic Function: Helpful to Diagnose and Assess Severity of Perinatal Asphyxia

Islam, Tariqul; Hoque, Seikh Azimul; Matin, MA; Islam, Nazrul; Hossain, Amjad; Nazir, Fahmida; Islam, Shahnoor

doi:10.3329/bjch.v34i1.5695

Cited by 9 publications

(18 citation statements)

References 14 publications

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“…In the present work, we observed significantly lower values of total protein and serum albumin in asphyxiated neonates and that they correlate poorly with the severity of birth asphyxia as assessed by HIE stage and Apgar score. Islam et al 11 reported mean total protein and serum albumin similar to our study in asphyxiated neonates. The prevalence of hypoproteinemia noted by Godambe and coworkers 16 was 34% in asphyxiated newborns.…”

Section: Discussionsupporting

confidence: 90%

“…The present work demonstrated that serum ALP increased more than the command group, and the differences were statistically significant, but significant correlation with stages of HIE was not established. Islam et al 11 reported mean ALP similar to our study in asphyxiated neonates, but showed significant correlation with stages of HIE.…”

Section: Discussionsupporting

confidence: 87%

“…In this study, the rise of TSB in asphyxiated newborns was statistically significant when compared with group B, although it was found to be within normal limit in asphyxiated babies. Similarly, TSB levels were reported in asphyxiated babies by Islam et al 11 (5.5 ± 2.01 mg/dL in asphyxia group versus 4.5 ± 1.2 mg/dL in normal neonates, P < 0.001).…”

Section: Discussionsupporting

confidence: 72%

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Hepatic Dysfunction in Asphyxiated Neonates: Prospective Case-Controlled Study

Choudhary

Sharma

Dabi

et al. 2015

Clin Med Insights Pediatr

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OBJECTIVEThis study was performed to determine the occurrence of hypoxic hepatitis in full-term neonates after perinatal asphyxia and to correlate between the rise in enzymes and severity of asphyxia with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates.METHOD AND MATERIALThis prospective case-controlled study was conducted in a tertiary-level hospital in India for a period of 12 months. The study group A comprised 70 newborns suffering from birth asphyxia, while 30 healthy neonates were included in group B (control). All biochemical parameters of liver function, ie, serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, bilirubin (total and direct), and international normalized ratio (INR), were measured on postnatal days 1, 3, and 10 in both study and control groups.RESULTSIn group A, 22.8% newborns had severe (Apgar score 0–3), 47.1% had moderate (Apgar score 4–5), and 30% had mild (Apgar score 6–7) birth asphyxia at five minutes. In all, 14.28% babies were in HIE stage I, 25.73% babies were in HIE stage II, and 11.42% babies were in HIE stage III. The rest of the newborns, 48.57%, were normal. The prevalence of liver function impairment was seen in 42.85% of asphyxiated neonates. On day 1, ALT, AST, ALP, LDH, PT, and INR were significantly higher, and total protein and serum albumin were significantly lower in group A than in group B. However, ALT and AST correlated well with increasing severity of HIE score. On day 3, there was a rising trend observed in the concentration of mean LDH as HIE staging of neonates progressed from stage 0 to stage III, and among various HIE stages, the difference in LDH was statistically significant.CONCLUSIONWe concluded that AST, ALT at 24 hours, and LDH at 72 hours of animation can be a utilitarian diagnostic tool to differentiate asphyxiated neonates from non-asphyxiated neonates and to discover the severity of perinatal asphyxia because of easy accessibility and feasibility of tests. The outcomes of this survey would be useful for physicians who receive neonates for whom birth details are not easily documented as most of the time the referred newborn infants lack asphyxia history either because the attendants do not know clearly the whole birth history or it was an unattended delivery, or the referring health-care professional has not been observant because of legal threats. The neurological assessment also becomes difficult and inconclusive as ventilator treatment, sedative drugs, and anticonvulsant therapy would produce an evaluation of severity of hypoxic ischemic brain disease and neurological insult difficult.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 72%

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Hepatic Dysfunction in Asphyxiated Neonates: Prospective Case-Controlled Study

Choudhary

Sharma

Dabi

et al. 2015

Clin Med Insights Pediatr

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“…This was similar to the results of the work done by Islam et al in 2010. 15 This was likely due to the fact that with increasing severity of hypoxic-ischemic injury, more of the enzymes were being released from the damaged cells. In contrary, Choudhary et al 22 reported no correlation between the levels of the enzymes and severity of PA using the Apgar scores.…”

Section: Discussionmentioning

confidence: 99%

“…There is need for biomarkers that can define the presence and severity of asphyxia in babies with severe PA, especially when the labor is not supervised by skilled personnel. Consequently, several studies [13][14][15][16] have been undertaken to determine the relationship between intracellular enzymes and PA. There is dearth of data in Nigeria, one of the major countries where PA is a major problem.…”

Section: Introductionmentioning

confidence: 99%

Lactate Dehydrogenase, Aspartate Aminotransferase, and Alanine Aminotransferase Cord Serum Levels as Early Markers of Hypoxic–Ischemic Encephalopathy in Babies with Severe Perinatal Asphyxia

et al. 2018

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Perinatal asphyxia is a major cause of morbidity and mortality among newborn babies. Severe perinatal asphyxia can be associated with multiple organ dysfunctions resulting in the release of a variety of intracellular enzymes. A major concern is how to identify newborns in need of prompt and aggressive management to minimize the risk of early severe neurological sequelae such as hypoxic–ischemic encephalopathy. The present study was performed to determine the relationship between cord serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and severity of perinatal asphyxia among Nigerian newborn babies. This was a prospective, comparative case–control study at the Obafemi Awolowo University Teaching Hospital, Ile-Ife. Cord blood was collected at delivery for serum levels of lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase. Each baby was evaluated for the severity of perinatal asphyxia at 1 minute of life using Apgar scores. Apgar score less than 7 at 1 minute was regarded as perinatal asphyxia. The Apgar scores were related to cord serum levels of the enzymes. The data were analyzed using Statistical Package for the Social Sciences for Windows, version 17.0. One hundred and forty babies, comprising 70 babies with and 70 babies without perinatal asphyxia were studied. Thirty-six (51.4%) of the neonates had severe perinatal asphyxia with Apgar score of 3 and below; 15 (41.7%) of the 36 had hypoxic–ischemic encephalopathy. The mean of values of each of the three enzymes was statistically significantly higher in babies with perinatal asphyxia compared with controls (p < 0.001 for each enzyme) and in babies with hypoxic–ischemic encephalopathy than in babies with severe perinatal asphyxia but without hypoxic–ischemic encephalopathy (p < 0.001). A very high proportion of babies with severe perinatal asphyxia developed hypoxic–ischemic encephalopathy. Based on the cord serum enzyme levels, almost all the babies who had hypoxic–ischemic encephalopathy would have been identified at delivery. Routine estimation of the cord serum levels of these enzymes among babies with severe perinatal may be used to identify babies who may develop acute serious neurological complications for anticipatory management.

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Biomarkers in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia

et al. 2020

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The aim of the presented study was to evaluate the differences between selected biochemical markers in infants with moderate or severe hypoxic-ischemic encephalopathy (HIE) and their impact on patient prognosis. Methods A total of 57 cooled newborns were divided into groups according to Sarnat staging of HIE (A, moderate vs. B, severe). The differences between groups were evaluated depending on the mode of delivery, pregnancy and labor complications, gestational age at birth, birth weight, and Apgar score at 1.3 and 5 min. The differences in biochemical biomarkers of HIE (pH, base excess, serum lactate) as well as biomarkers of hepatic injury (aspartate transaminase, (AST), alanine transaminase (ALT), prothrombin time (PT), and activated partial thromboplastin time (APTT)), kidney failure (creatinine, urea), myocardial injury (troponin T (TnT)), levels of fibrinogen, and platelet counts were also examined. Univariate Kaplan-Meier method was used for survival analyses. Results The biomarker levels in severe HIE newborns compared with moderate were as follows: pH (7.10 vs. 6.99), serum lactate (22.50 vs. 17.00 mg/dL), AST (109.50 vs. 270.55 IU/L), ALT (27.30 vs. 108.05 IU/L), PT (17.00 vs. 44.20 s), APTT (47.75 vs. 47.90 s), TnT (0.22 vs. 0.85 ng/mL), creatinine (0.68 vs. 1.15 mg/dL), urea (44.55 vs. 73.30 mg/dL), and fibrinogen (1.65 vs. 1.90 mg/dL). Survival analyses showed significantly reduced survival for severe HIE infants (75%) vs. moderate HIE (100%). Conclusion In conclusion, the severity of HIE can be evaluated based on selected markers; however, their levels do not correspond with future prognosis of newborns.

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Alteration of Hepatic Function: Helpful to Diagnose and Assess Severity of Perinatal Asphyxia

Cited by 9 publications

References 14 publications

Hepatic Dysfunction in Asphyxiated Neonates: Prospective Case-Controlled Study

Hepatic Dysfunction in Asphyxiated Neonates: Prospective Case-Controlled Study

Lactate Dehydrogenase, Aspartate Aminotransferase, and Alanine Aminotransferase Cord Serum Levels as Early Markers of Hypoxic–Ischemic Encephalopathy in Babies with Severe Perinatal Asphyxia

Biomarkers in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia

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