Abstract
Objectives To determine the usefulness of creatine kinase (CK) alone or in combination with lactic dehydrogenase (LDH) in identifying, those infants at risk of developing hypoxic ischaemic encephalopathy (HIE) or a major handicap following perinatal asphyxia. Design Prospective observational study. Method CK and LDH in serum were measured in 35 asphyxiated infants and in 30 controls within 6 hours of delivery. The asphyxiated newborns were monitored for evidence of HIE. Both groups were followed up in paediatric outpatients clinic and a developmental assessment was done at the end of one year. Results Both the CK and LDH levels were significantly raised in all asphyxiated newborns. 25.7% of asphyxiated babies developed HIE. The CK and LDH values of those who developed HIE were significantly higher than the rest of the asphyxiated newborns. Five babies had developmental delay and their CK values too were significantly higher. The same relationship was not seen with their LDH values. Conclusion Both the CK and LDH values are raised in birth asphyxia. The increase is more marked among those who developed HIE. However, only the raised CK levels correlated with long-term outcome. Babies with CK values above 2860 IU/ L should be closely monitored for both the immediate and longterm sequelae. Sri Lanka Journal of Child Health , 2000; 29 : 49-52 (Key words: creatine kinase, lactic dehydrogenase, markers of perinatal asphyxia) doi: 10.4038/sljch.v29i2.604
Highlights
Prediction of outcome of perinatal asphyxia is important but formidable[1]
The creatine kinase (CK) and lactic dehydrogenase (LDH) values of those who developed Hypoxic Ischaemic Encephalopathy (HIE) were significantly higher than the rest of the asphyxiated newborns
Since cerebral function monitoring (CFM) and the measurements of neurophysiological markers mentioned above are not routinely available in Sri Lanka, we examined the serum levels of CK and LDH to determine whether CK level alone or in combination with LDH level could be used as an indicator in selecting at a very early stage, those infants at risk of developing HIE or long term sequelae such as neurological abnormality or developmental delay
Summary
Prediction of outcome of perinatal asphyxia is important but formidable[1]. The Apgar score has a limited role in predicting the immediate outcome, 1Consultant Paediatrician, 2Registrar, 3Senior House Officer, Paediatric Unit, Colombo South Teaching Hospital.such as that of Hypoxic Ischaemic Encephalopathy (HIE) and the long-term sequelae[2]. Several studies have shown that cerebral function monitoring (CFM) using non invasive techniques, such as EEG within six hours of birth, cranial ultrasonography, cranial topography, Doppler measurements of cerebral blood flow, somato-sensory evoked potentials, magnetic resonance imaging and estimation of neurophysiological markers such as brain specific creatine kinase (CK-BB), brain specific lactic dehydrogenase isomer, glutamate and neurone specific enolase in the CSF are all useful in predicting both the immediate dysfunction and the long term outcome[1,3,4]. None of these facilities are routinely available, even in the teaching hospitals of this country. The precise mechanisms of neuronal loss are unclear, both apoptosis and necrosis seem to contribute to causing cell death following hypoxic ischaemia
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