Urinary Allantoin Is Elevated in Severe Intraventricular Hemorrhage in the Preterm Newborn

Abstract

Background Germinal matrix intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage observed in preterm neonates. It is a precursor of poor neurocognitive development, cerebral palsy and death. The pathophysiology is not well defined, but damage to the fragile germinal matrix vasculature may be due to free radicals generated during inflammation and as a consequence of ischemia followed by reperfusion. Assessment of the oxidative stress status in these infants is therefore important. Urinary allantoin concentration was measured in preterm neonates as a marker of oxidative stress associated with IVH. Study design Urine was collected from 44 preterm neonates at four time points between 24 and 72 hours of life (HOL) and the allantoin content was determined by gas chromatography mass spectrometry (GCMS). Records were retrospectively reviewed and the incidence and severity of IVH was categorized as follows: no IVH (n=24), mild (grade 1-2) IVH (n=13) and severe (grade 3-4) IVH (n=7). Results Neonates with severe IVH showed significantly elevated allantoin levels vs subjects with no IVH from 36 HOL (0.098±0.013µmol and 0.043±0.007µmol, respectively, p=.002). The allantoin concentration remained elevated even at 72 HOL (0.079±0.014µmol and 0.033±0.008µmol, respectively, p=.021). There were no significant differences in allantoin levels in the no IVH and mild IVH groups. IVH was diagnosed by head imaging on average at about 11th post-natal day. Conclusion Urinary allantoin levels were significantly elevated during the first 3 days of life in the neonates subsequently diagnosed with severe IVH, suggesting that oxidative stress might be a crucial factor in IVH pathogenesis. Further studies are needed to assess the usefulness of urinary allantoin in early identification of preterm infants at risk for or with severe IVH, and monitoring of the response to interventions designed to prevent or treat it.

The Association of Kangaroo Mother Care, Energy Conservation, and Bonding in Preterm Neonates

“…Chi Luong et al (2016) briefly alluded to the increased consumption of energy for thermal regulation and hypoglycemia in the incubator group. Preterm neonates' ATP or energy stores are limited and susceptible to cell injury due to ATP depletion (Esiaba et al, 2016). Kangaroo mother care has the potential to alter biochemical markers of ATP utilization, oxidative stress, and cell injury.…”

“…However, the difference in energy costs at the cellular level is currently unknown. The evidence of the cumulative effect of destabilization in cardiorespiratory parameters can lead to ATP depletion and could result in potentially dangerous metabolic dysfunction and cell injury (Esiaba et al, 2016).…”

“…Currently, there are no biochemical biomarkers of stress signaling a reduction in inflammatory processes in the presence of KMC. Esiaba et al (2016) conducted a study using urinary allantoin as a marker of oxidative stress in germinal matrix intraventricular hemorrhage (IVH) in preterm newborns. Allantoin is produced in humans by free radicals of nonenzymatic oxidation of uric acid following oxidative stress associated with inflammatory processes (Esiaba et al, 2016).…”

“…Esiaba et al (2016) conducted a study using urinary allantoin as a marker of oxidative stress in germinal matrix intraventricular hemorrhage (IVH) in preterm newborns. Allantoin is produced in humans by free radicals of nonenzymatic oxidation of uric acid following oxidative stress associated with inflammatory processes (Esiaba et al, 2016). The measurement of allantoin has been validated in adults and in neonates, and elevated allantoin concentrations have been found in connection to increased ATP utilization and necrotizing enterocolitis.…”

“…The measurement of allantoin has been validated in adults and in neonates, and elevated allantoin concentrations have been found in connection to increased ATP utilization and necrotizing enterocolitis. Esiaba et al (2016) enrolled infants at less than 34 weeks gestation (n=44) and categorized them based on the presence of IVH as diagnosed by head ultrasound and/or magnetic resonance imaging. Demographic variables were homogenous for gestational age, birth weight, and 1-minute Apgar Scores.…”