Hepatic Injury in Neonates with Perinatal Asphyxia

Abstract

Background: Perinatal asphyxia (PA) is a major cause of morbidity and mortality in which dramatic transient impairment in liver functions occurs in some patients. Objectives: We aimed to evaluate the state of the liver in cases of Perinatal asphyxia and to assess the severity of hepatic impairment in relation to different grades of HIE. Patients and Methods: This case-control study was conducted on 100 full-term newborns with perinatal asphyxia (Group I) and 50 healthy neonates served as controls (Group II). All biochemical parameters of liver function were measured on the 1st, 3rd, and 10th day after birth. These parameters include serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, serum bilirubin (total and direct), and international normalized ratio (INR), in both cases and controls. Results: Among babies with PA, 25 (25%) had an Apgar score of 0 to 3 (severe PA), 43 (43%) had an Apgar score of 4 to 5 (moderate PA) and 32 (32%) had an Apgar score of 6 to 7 (mild PA) at 5 minutes of life. HIE was found in 39% among cases of PA and the remaining 61% were normal. Among babies with PA and HIE; 25.7% had stage I, 41% had stage II and 33.3% had stage III. Impaired liver function was reported in 48% of asphyxiated babies. On the first day of life, ALT, AST, ALP, LDH, PT, and INR were significantly higher in Group I compared to Group II. However, total protein and serum albumin were significantly lower in Group I compared to Group II. ALT and AST showed a positive correlation with the severity of HIE. On the third day of life, LDH rises as the stage of HIE progressed from stage 0 to stage 3. The difference in LDH among most stages of HIE was statistically significant. Conclusion: Liver enzymes can be used as an easy early diagnostic marker to differentiate between babies with asphyxia and those without asphyxia. Also, liver enzymes can be used for the detection of the severity of PA.

A comparative study of liver function test between normal neonates and neonates with different stages of hypoxic ischemic encephalopathy in a district medical college of Eastern India

“…Islam et al, and contradicted by some like the Elsadek et al, study, where they found no significant correlation between serum level of ALP and stages of HIE [9][10][11]. In our study, we have shown that how mortality is increased from lower to higher HIE stages (nil in HIE I to 29.42% in HIE III).…”

“…This finding is similar to other studies like Elsadek et al, or Choudhury et al, where they described total protein and serum albumin significantly low in babies with perinatal asphyxia. 6,9 In the present study, levels of ALT, AST, and ALP are significantly higher among different stages of HIE, from mild to severe. However, TSB, PT, and serum albumin did not have any significant difference with increasing severity of HIE.…”

“…In our study, also PT is significantly higher in HIE group as compared to control which is in accordance to some previous study like Elsadek et al, study, where they have found PT and INR significantly higher in HIE babies. 9 Serum albumin is also a marker of hepatic integrity and it is decreased when the synthetic function of liver is hampered by hypoxic ischemic damage. In our study, we have found serum albumin significantly low in HIE group in comparison to the control group.…”

Hemostasis in Neonates with Perinatal Hypoxia—Laboratory Approach: A Systematic Review

“…All infants with coagulopathy received blood product transfusion. Elsadek et al 35 and Choudhary et al 36 addressed the issue of hepatic function impairment in hypoxic neonates and came to the same conclusion; PT and INR were markedly higher in hypoxic neonates compared with healthy ones. Mautone et al 37 found no statistically significant difference in the coagulation and fibrinolytic systems of asphyxiated and healthy neonates; platelet count, PT, aPTT, D-dimers, fibrinogen, and antithrombin III were similar between the two groups.…”

Clinical, biological and electroencephalographic monitoring of newborns with neurological risk in the Neonatal Intensive Care Unit

“…HIE is a term to define the disturbed neurological function in the earliest days of life in the term newborn, consisting in the alteration of the level of consciousness, tone and neonatal reflexes, including the sucking and swallowing reflex, the presence of seizures in moderate and severe stages of HIE ( 5 , 8 ) and cardiovascular (bradycardia, hypotension) and respiratory disorders (irregular respiration, apnea) in severe HIE ( 5 , 9 ). Furthermore, severe HIE includes multisystem involvement, not only neurological, but also cardiac, renal, liver damage ( 4 , 5 , 10-12 ) and fluctuations in the glycemic values (generally, hypoglycemia) ( 4 ).…”