Study of Urinary Uric Acid and Creatinine Ratio as a Marker of Perinatal Asphyxia and Its Correlation with Different Stages of Hypoxic Ischemic Encephalopathy

Abstract

Background: Birth asphyxia is one of the leading causes of neonatal mortality in India. Hypoxic-ischemic encephalopathy (HIE) is the neurological manifestation of systemic hypoxia in new-born. 20-25% of asphyxiated babies who exhibit severe HIE, die during the new-born period. The most commonly used diagnostic and prognostic index to evaluate asphyxia in neonates is APGAR score but alone it is not useful to ferret out neurological outcome. Now-a-days uses of biomarkers enable the clinicians to screen infants for brain injury. We conducted this study to evaluate the role of UUA (urinary uric acid)/Cr (creatinine), which is an early biomarker, in diagnosing and predicting the outcome in perinatal asphyxia. Aim: To determine the values of UUA/Cr in new-borns with perinatal asphyxia and its relation with different stages of HIE. Methods: Spot urine samples were collected from the 100 asphyxiated and 100 healthy neonates within 6-24 h of life for determining uric acid and creatinine by auto analyses. Results: The value of UUA/Cr were statistically significantly higher in the asphyxiated (case) compared with the control group. UUA/Cr ratios were significantly higher in infants with severe HIE (3.61 ± 0.61) when compared with infants with Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation moderate HIE (2.95 ± 0.98: P<0.01) and those with mild HIE (2.64 ± 0.25: P<0.001). Conclusion: UUA/Cr concentration increase considerably after birth asphyxia and is non-invasive, sensitive, early and cost effective method for assessment of asphyxia and its outcome.