50 Years Ago in The Journal of Pediatrics: Uric Acid Levels in Full-Term and Low-Birth-Weight Infants

Abstract

Marks JF, Kay J, Baum J, Curry L. J Pediatr 1968;73:609-11. In the 1960s, uric acid became a metabolite of interest in the newborn. The main reason was the description by Lesch and Nyhan in 1964 of a new X-linked syndrome characterized by mental retardation, spasticity, and self-mutilation.1Lesch M. Nyhan W.L. A familial disorder of uric acid metabolism and central nervous system function.Am J Med. 1964; 36: 561-570Abstract Full Text PDF PubMed Scopus (900) Google Scholar In 1967, it was reported that deficiency of the enzyme hypoxanthine guanine phosphoribosyl transferase, which is needed for purine salvage, was present in these patients.2Seegmiller J.E. Rosenbloom F.M. Kelly W.N. Enzyme defect associated with a human sex-linked neurological disorder and excessive purine synthesis.Science. 1967; 155: 1682-1684Crossref PubMed Scopus (729) Google Scholar This is the background for the study by Marks et al in The Journal 50 years ago reporting serum uric acid levels in full term and low-birth weight infants the first days of life. In full-term infants cord blood levels were higher than maternal levels peaking at day 1 declining to maternal levels at day 2. In low birth weight infants, uric acid reached higher levels than in full-term infants with a peak 1 day later. Still, the values of 5-6 mg/100 mL was far below levels of a patient with the Lesch-Nyhan syndrome of 8.0 mg/100 mL in cord blood and 18.9 mg/100 mL at the age of 24 hours.3Marks J.F. Baum J. Keele D.K. Kay J.L. MacFarlen A. Lesch-Nyhan syndrome treated from early neonatal period.Pediatrics. 1968; 42: 357-359PubMed Google Scholar In the early 1970s, a new interest in uric acid among newborns was aroused due to its potentiality as an asphyxia marker. Thus, Raivio found higher serum uric acid concentrations the first 3 days of life in premature infants with respiratory distress syndrome compared with normal term infants.4Raivio K. Neonatal hyperuricemia.J Pediatr. 1976; 88: 625-630Abstract Full Text PDF PubMed Scopus (32) Google Scholar It was, however, understood that hypoxanthine—the precursor of uric acid—is a more sensitive marker of hypoxia than uric acid. Today uric acid is recognized as an important antioxidant in the newborn period explaining why a peak immediately after birth may be beneficial. However, in spite of a high uric acid level, an increased oxidative stress probably is present in patients with Lesch-Nyhan.5Saugstad O.D. Marklund S.L. High activities of erythrocyte glutathione peroxidase in patients with the Lesch-Nyhan syndrome.Acta Med Scand. 1988; 224: 281-285Crossref PubMed Scopus (11) Google Scholar