Hepatic Dysfunction in Asphyxiated Neonates: Prospective Case-Controlled Study

Abstract

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.

A Study on Plasma Biochemical Phenomena in Hypoxic-Ischaemic Encephalopathy Cases in Tertiary Care Hospital

“…This study is similar to the findings observed by Mukesh Choudhary, [7] Tariqul I et al [33] and Chaitali Patra et al [34] The Table 9 depicts that 2 babies from HIE-2 group died, one within 1 -3 days and the other one within 4 -7 days.…”

“…Chiabi A and Nguefack S et al (2013) [10] that out of total number of asphyxiated babies 51% were HIE-1, 26% were HIE-2 and 23% were HIE-3. Mukesh Choudhary et al (2015) [7] in their study observed 14.28% were HIE-1; 25.73% were HIE-2; 11.42% were HIE-3. Hassan Boskabadi et al (2015) [11] in their study found HIE-1 were 11.86%; HIE-2 were 45.76%; HIE-3 were 42.37%.…”

“…The study cohort consisted of the hospitalised term neonates of birth weight ≥ 2.5 kg to the indoors/ S.N.C.U of S.C.B M.C.H and S.V.P.P.G.I.P, Cuttack with diagnosis of birth asphyxia as per the following defined criteria. [7,8,9] Inclusion Criteria Apgar score < 7 at 5 minutes of birth, 2. Delayed onset of respiration for ≥ 5 minutes, 3.…”

“…Later on the peak aminotransferase level returns to near normal within 10 days. [7] The prognosis of hypoxic hepatitis itself is safe, and it rarely progresses into complete hepatic failure. With improved survival of sick asphyxiated neonates because of improvements in medical care, the clinical entity of liver involvement is being increasingly recognised, and so this work was planned to recognise the prevalence of liver involvement in birth asphyxia and to study the severity and type of hepatic dysfunction in relation to Apgar score and HIE grading of asphyxiated newborns.…”

Preventing deaths from complications of labour and delivery

“…Renal dysfunction due to acute tubular necrosis is usually transient and resolves in the first week [51]. Liver damage manifests as elevated transaminases and may exacerbate coagulation problems [52]. Early aggressive enteral feeding should be avoided as this may precipitate necrotizing enterocolitis [53].…”