Cord blood ischemia‐modified albumin: Is it associated with abnormal Doppler findings in complicated pregnancies and predictive of perinatal asphyxia?

Abstract

Aim: To evaluate the significance of the cord blood ischemia-modified albumin (IMA) level as a diagnostic marker for perinatal asphyxia and to determine the associations of IMA levels with the complexity of pregnancy and abnormal Doppler findings, regardless of perinatal asphyxia. Methods: This prospective study included 169 newborns, sixteen of whom had perinatal asphyxia and 33 who were from complicated pregnancies. Doppler measurements were obtained from the uterine, umbilical and middle cerebral arteries, and the cerebro/placental ratio (C/P). IMA was measured by means of commercially available ELISA kits and was expressed as picomoles per milliliter. Results: Ischemia-modified albumin levels were significantly higher in neonates of complicated pregnancies as compared to uncomplicated pregnancies (P < 0.0001). They were higher in newborns with perinatal asphyxia as compared to healthy controls (P = 0.015). The C/P ratio-pulsatility index (PI) showed a significant difference between normal and complicated pregnancies without perinatal asphyxia (P < 0.0001). IMA levels were significantly increased in cases with abnormal C/P ratio-PI. Conclusions: Elevated cord blood IMA levels may be accepted as a useful marker in perinatal asphyxia. Abnormal Doppler examinations are associated with elevated IMA levels in complicated pregnancies.

Serum Ischemia-Modified Albumin in Preterm Babies with Respiratory Distress Syndrome

“…The mechanism of IMA generation remains unexplained. It has been suggested that IMA is a modification of serum albumin, and it results from oxidative stress and concurrently produced superoxide-free oxygen radicals that occur during ischemic events, regardless of tissue specificity [7][8][9]12]. Recently, some studies have reported that IMA has a relationship with various ischemia-related conditions, such as acute coronary syndrome, ischemia of liver, brain, kidney, and bowel in adults [7,15,16].…”

“…Therefore, infants with RDS expose to severe hypoxia [4]. Current studies have determined that cord blood levels of IMA are higher in perinatal asfixia and complicated deliveries associated with fetal distress, hypoxia, and oxidative stress in newborns [11,12,19,20], and IMA has been declared to be a good marker for diagnosis of asphyxia. RDS is known a severe disease that leads to severe hypoxia and further deleterious neurodevelopmental outcomes of preterm infants and mortality without appropriate respiratory support and surfactant therapy.…”

“…Yakut et al [13] have reported that IMA levels are sensitive and effective marker for diagnosing NEC in close association with intestinal hypoxia, monitoring and decision-making for surgery in preterm infants. Kumral et al [12] have stated that asphyxia in low birth weight infants exists more than term infants, and this situation increases reactive oxygen species [21]. Therefore, oxidative stress in preterm infants with insufficient oxygenation may contribute to increase in the IMA levels.…”

“…Furthermore, few studies have determined that cord blood levels of IMA are higher in perinatal asfixia and complicated deliveries thought to be associated with fetal distress, hypoxia and oxidative stress in newborns. Additionally, some clinical and experimental studies have recently indicated elevated levels of IMA in ischemic and hypoxic conditions such as necrotizing enterocolitis (NEC) in newborns [10][11][12][13]. In these considerations, the primary aim of this study was to evaluate the diagnostic significance of serum IMA level in newborns with RDS which is a leading cause of hypoxia particularly in preterm infants.…”

Ischemia‐modified albumin in preterm infants born to mothers with pre‐eclampsia

“…It is generally accepted that IUGR and fetal hypoxia are currently related to placental insufficiency . In a recently published study, increased cord blood IMA was recognized as a useful biomarker in neonates with perinatal asphyxia …”