Study of urinary uric acid and creatinine ratio as a marker for neonatal asphyxia

Abstract

Introduction and Objectives: Perinatal asphyxia is a common neonatal problem at times devastating because of its potential for causing permanent damage and even death of the newborn. In the absence of perinatal records, it is difficult to retrospectively diagnose perinatal asphyxia. The Apgar score describes the wellness of the newborn immediately after birth and when properly applied is a tool for standard assessment. The Apgar score does not predict neonatal mortality or neurological outcome. So it is inappropriate to use Apgar score alone to establish the diagnosis of asphyxia. In recent studies new biochemical markers are being evaluated for early diagnosis of asphyxia. ATP degradation products such as hypoxanthine and uric acid are valuable indicators of tissue hypoxia. In cases of continuing tissue hypoxia urinary excretion of uric acid is increased. The main objective of this study was to evaluate prospectively by measuring uric acid to creatinine (Ua/Cr) ratio in early spot urine samples in diagnosing perinatal asphyxia, and to assess the relationship between urinary uric acid to creatinine ratio and severity of HIE. Materials and Methods: This is a analytical cross sectional study done in the neonatal intensive care unit in Government Raja Mirasudar Hospital attached to Thanjavur Medical College, Thanjavur, South India form January 2016 to July 2016. Case and control group comprising of 50 asphyxiated and 50 non asphyxiated neonates were enrolled. Urine samples were collected within 24 hours of birth and urinary uric acid and creatinine levels measured. Urinary uric acid to creatinine ratio value of > 1.22 was taken as the cut-off level. Results: The urinary Ua/Cr ratios were found to higher in asphyxiated neonates (2.59+-1.04) when compared with those in the controls (0.72+-0.16, p Conclusions: Urinary uric acid / creatinine ratio can be used as a marker in the diagnosis of perinatal asphyxia and staging of HIE. Keywords: Urinary uric acid, Apgar sc