Early predictors of brain damage in full-term newborns with hypoxic ischemic encephalopathy

Abstract

Objective of the studyTo evaluate the value of serum creatine phosphokinase-brain specific (CK-BB) and urinary lactate/creatinine (L/C) ratio as early indicators of brain damage in full-term newborns with hypoxic ischemic encephalopathy (HIE).Patients and methodsA case–control study including 25 full-term new-born infants with perinatal asphyxia who were admitted to neonatal intensive care unit (NICU) with a proven diagnosis of HIE, compared to 20 healthy age- and sex-matched full-term newborns. All newborn infants were subjected to full history taking, clinical examination, routine investigations (cord blood gases and complete blood picture), and assessment of serum CK-BB (cord blood, 6 and 24 hours after birth) and urinary L/C ratio (collected within the first 6 hours, on the 2nd and 3rd day after birth).ResultsThe serum CK-BB and urinary L/C ratio in infants with HIE were significantly higher in samples collected throughout the monitoring period when compared with the control group (all P<0.001). The cord CK-BB and urinary L/C ratio within the first 6 hours were significantly higher in infants with severe HIE than in infants with mild and moderate HIE (P<0.001). Cord CK-BB level at 12.5 U/L had 100% sensitivity and 84% specificity in the detection of severe HIE infants. Urinary L/C ratio of more than 10.5 collected within the first 6 hours after birth had 100% sensitivity and 78% specificity for the detection of severe HIE infants.ConclusionThe serum CK-BB and urinary L/C ratio in HIE infants were significantly increased early in the course of the disease, which can be used as useful indicators for predicting the development of HIE.

Analysis of Clinical Related Factors of Neonatal Hand-Foot-Mouth Disease Complicated With Encephalitis

“…In this study, the CK-BB level in the CSF of the abnormal NBNA score group was higher than that of the normal NBNA score group. Alkholy et al ( 15 ) studies believe that CK-BB can be used as an important index to evaluate the prognosis of neonatal hypoxic-ischemic encephalopathy, and monitoring the level of CK-BB is helpful to evaluate the condition and prognosis of neonatal hypoxic-ischemic encephalopathy. Therefore, the level of CK-BB in CSF can be used as one of the evaluation indicators for the clinical diagnosis and treatment of neonatal HFMD with encephalitis.…”

Which factors predict outcomes of neonates with hypoxic-ischemic encephalopathy following therapeutic hypothermia?

“…Around 20-50% of infants with HIE die early in infancy, and 25-60% of surviving infants have long-term neurological disorders such as cerebral palsy, epilepsy, intellectual disability, and learning disabilities. 1) Studies of therapeutic hypothermia (TH), the current standard therapy (33-34°C for 72 hours within 6 hours of birth), decreased mortality with relative risk (RR) of 0.75 (95% confidence interval [CI], 0.64-0.88; risk difference [RD], -9%), and neurodevelopmental disability in survivors with RR of 0.67 (95% CI, 0.55-0.80; RD, -13%) in infants ≥35 weeks' gestational age with moderate to severe HIE. 2,3) TH also decreased the neuromotor delay (Bayley Scales of Infant Development -Mental Development Index, more than 2 SD below the mean; RR, 0.75; 95% CI, 0.59-0.94; RD, -9%) and developmental delay (Bayley Scales of Infant Development -Mental Development Index, more than 2 SD below the mean; RR, 0.74; 95% CI, 0.58-0.94; RD, -10%) in survivors and decreased the risk of cerebral palsy in survivors with RR of 0.66 (95% CI, 0.64-0.88; RD, -12%).…”

“…2) Additionally, elevated levels of serum protein S100, glial fibrillary acid protein, UCH-L1, interleukin (IL)-6, IL-16, Activin A, and cerebrospinal fluid neuron-specific enolase and IL-1β were significantly associated with abnormal outcomes in survivors. 1,2,6,7) Sabahi et al showed that the need for advanced neonatal resuscitation (OR, 23.55; 95% CI, 2.3-238.6; P = 0.0075) was an independent predictive factor of death, while severely abnormal aEEG findings (OR, 63.0; 95% CI, 7.9-504.6; P = 0.0001) were independent predictive factors of severity in infants with HIE. 8) The combination of biomarkers and neonatal resuscitation level may provide a rapid and accurate method of predicting moderate to severe HIE.…”

“…Hypoxic-ischemic encephalopathy (HIE), which develops after perinatal asphyxia, is a leading cause of death or long-term neurological impairment in infants born at term or near term. Around 20%–50% of infants with HIE die early in infancy, and 25%–60% of surviving infants have long-term neurological disorders such as cerebral palsy, epilepsy, intellectual disability, and learning disabilities [ 1 ]. Studies of therapeutic hypothermia (TH), the current standard therapy (33°C–34°C for 72 hours within 6 hours of birth), decreased mortality with relative risk (RR) of 0.75 (95% confidence interval [CI], 0.64–0.88; risk difference [RD], -9%), and neurodevelopmental disability in survivors with RR of 0.67 (95% CI, 0.55–0.80; RD, -13%) in infants ≥35 weeks’ gestational age with moderate to severe HIE [ 2 , 3 ].…”

“…In addition, some studies have shown that decreased heart rate variability has the potential for severity assessment and long-term prognosis predictions in infants with HIE [ 2 ]. In HIE infants, increased serum CK-BB and urine lactate/creatinine ratios were observed at disease onset, making them useful predictors of HIE [ 1 ]. In an umbilical blood gas analysis, a pH <7.00 indicates a 50% chance of an abnormal outcome; however, its positive predictive value for moderate to severe HIE is low [ 2 ].…”