Abstract
Background: Cerebral hypoxia can result in anaerobic glycolysis which leads to decreased phosphorylase production and increased uric acid which gets excreted in the urine where it can be easily detected. The aim of the study is to assess the utility of urine uric acid creatinine ratio (UA/Cr) as an additional marker of neonatal depression and birth asphyxia and its utility as a potential prognostic indicator for the immediate outcome. Subjects and Methods: It was a case-control study that included 30 newborns born with an APGAR score of less than 7 at 1-min and requiring positive pressure ventilation. Cases were sub-grouped into neonatal depression and birth asphyxia. Newborns with moderate and severe encephalopathy were considered to have an unfavourable outcome. The urine UA/Cr was estimated in both groups. One-way Anova test, Spearman’s rho and Receiver Operating Characteristic curve were used for statistical analysis. Results: The mean differences of urine UA/Cr were statistically significant (p=0.011) in birth asphyxia (3.02 1.34), neonatal depression (2.31 0.81) and controls (2.01 0.69). A significant negative correlation was seen with APGAR at 1-min (r=-0.43; p=0.001) and 5-min (r=-0.52; p=0.001) and umbilical cord blood pH (r= -0.29; p=0.021). The mean difference of UA/Cr between those with unfavorable (3.23 1.49) and favourable (2.14 0.73) outcomes was significant (p=0.006). A ratio 2.85 suggested the unfavourable outcome. Conclusion: The urine UA/Cr is a useful diagnostic and prognostic biomarker in newborns with birth asphyxia.
Highlights
Neonatal depression is a descriptive term to describe any newborn showing a prolonged transition from intrauterine to extrauterine life
Birth asphyxia is associated with mortality of 15-20% and morbidity of 25%
There is a decrease in glucose and Adenosine triphosphate (ATP) production due to anaerobic glycolysis
Summary
Neonatal depression is a descriptive term to describe any newborn showing a prolonged transition from intrauterine to extrauterine life. Phosphates are catabolized to adenosine, inosine, hypoxanthine and in the presence of xanthine oxidase, further to xanthine and uric acid These metabolites enter the blood from damaged tissues and are excreted in the urine where they can be detected. Cerebral hypoxia can result in anaerobic glycolysis which leads to decreased phosphorylase production and increased uric acid which gets excreted in the urine where it can be detected. The aim of the study is to assess the utility of urine uric acid creatinine ratio (UA/Cr) as an additional marker of neonatal depression and birth asphyxia and its utility as a potential prognostic indicator for the immediate outcome. Results: The mean differences of urine UA/Cr were statistically significant (p=0.011) in birth asphyxia (3.02±1.34), neonatal depression (2.31±0.81) and controls (2.01±0.69). Conclusion: The urine UA/Cr is a useful diagnostic and prognostic biomarker in newborns with birth asphyxia
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