Lack of Prognostic Significance of Early Elevated Serum Uric Acid Levels in Low Birthweight Infants

Abstract

This study examined the utility of serum uric acid concentrations in the first day of life to identify infants with severe brain injury (grade III or IV intraventricular hemorrhage and/or periventricular leukomalacia). The serum uric acid concentrations in infants with severe brain injury were compared to those without. Severe brain injury was assessed in 151 infants with birthweight ≤1,251 g admitted before 24 h of life. The risk of severe brain injury was related to 5-min Apgar scores (odds ratio 0.79, CI 0.63–0.98, p < 0.05) and seizures in the first day of life (odds ratio 4.44, CI 1.004–19.66, p < 0.05), but the mean uric acid levels did not differ between those with and without severe brain injury [5.11 ± 1.88 mg/dl (303.9 ± 111.8 µmol/l) vs. 5.77 ± 2.13 mg/dl (343.2 ± 126.7 µmol/l), p = 0.200]. Uric acid levels were related to serum creatinine (p < 0.001), time of uric acid sample (p < 0.001), maternal hypertension (p < 0.001), and base deficit (p = 0.032). Of the 80 infants seen in neurodevelopmental follow-up at a median 11 months postconceptional age, uric acid concentrations did not differ between the abnormal (n = 20) and normal subjects [5.38 ± 1.72 mg/dl (320.0 ± 102.3 µmol/l) vs. 6.02 ± 2.55 mg/dl (358.1 ± 151.8 µmol/l), p = 0.197]. Uric acid may not be a useful early marker for premature infants with severe brain injury.

Biomarkers of Brain Injury in the Premature Infant

“…In support of these findings, Aliefendioglu et al (2006) found that high UA concentrations in CSF were associated with a higher risk of IVH. However, other study of low birth weight infants did not find association between elevated UA in serum and IVH (Sysyn and Rozycki, 2003). UA has conflicting results as brain injury biomarker.…”

Perinatal biomarkers in prematurity: Early identification of neurologic injury

“…UA has also been studied as a biomarker for brain injury in prematurity. Perlman and Risser (1998) reported increased UA concentrations on the first postnatal day of life in preterm infants who developed IVH, although Sysyn and Rozycki (2003) failed to demonstrate a statistically significant correlation between UA and IVH in preterm infants.…”

Free Radicals and Neonatal Brain Injury: From Underlying Pathophysiology to Antioxidant Treatment Perspectives

“…On the other hand, the relationship between plasma UA and the development of severe IVH or PVL in preterm neonates is controversial. Pearlman et al reported increased UA concentrations on the first postnatal day in ELBW infants developing severe IVH/PVL, even after adjustment for GA and other relevant clinical variables [ 105 ]; subsequent data from a larger sample of preterm neonates with similar brain injury, however, failed to confirm this association [ 106 , 107 ]. Finally, significantly higher UA levels were observed in the CSF of preterm neonates with IVH grade 2 to 4 [ 107 ].…”