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Category: Volume 05 Issue 07 July 2017
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Title: Urinary Uric Acid/Creatinine Ratio as an Additional Early Marker for Perinatal Asphyxia

Authors: Dr Manish Kumar, Dr Nilesh Jain, Dr Sharad Thora, Dr Tripti Kiran

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i7.136

Abstract

Background: Perinatal asphyxia is one of the leading causes of perinatal morbidity and mortality.  Feasible and early biochemical marker to diagnose and predict neurologic outcome is a great need of time as Apgar score alone is influenced by various factors. This study was conducted to validate the utility of urinary uric acid to creatinine ratio (UA/Cr ratio) in asphyxia diagnosis.

Aim: To validate the urinary uric acid/creatinine ratio as an additional marker for perinatal asphyxia.

Materials and Methods: The present case control study was conducted at a tertiary care superspeciality Hospital associated with medical college. Data of 50 healthy newborns and 79 asphyxiated newborns were collected.  (UA/Cr) ratio was measured from the spot urine sample collected within 24 hours of birth. Statistical analysis was performed by student t-test and Receiver Operating Characteristic (ROC) plots.

Results: In our study the mean value of urine UA / Cr ratio among the cases was 2.632 and among controls was 0.866 (p <0.0001) and UA /Cr as an individual variable were statistically significant. ROC curve analysis done proved that a score of 1.92 or more delineates babies into asphyxiated newborns. A score of 1.9 has a sensitivity of 94.8% and specificity of 94% and area under the ROC curve is 0.995.

Conclusions: diagnosis of perinatal asphyxia should be supported by other investigations so that early decision can be taken about the level of care and prognosticate the baby. Interleukins, enzymes and imaging techniques require experienced personnel well equipped laboratories and are expensive. Non-invasive urinary UA/Cr ratio may be an answer to these issues as it easy, time and cost effective.

References

  1. Erdag GC, Vitrinel A, “Can urinary uric acid/ creatinine ratio be used as an additional marker for neonatal asphyxia.” International Pediatrics 2004; vol 19(4): 217-219.
  2. Aurora S, Snyder EY, Perinatal asphyxia. In: John P Cloherty et al, Manual of neonatal care, Lippincott Williams and Wilkins, 5th ed. 2004, Chap 27: 536-555.
  3. Stoll BJ, Kleigman RM, Nervous system Disorders. In: Behrman RE, Kleigman RM, Jenson HB. In: Nelson’s Textbook of Pediatrics, Saunders,17th ed 2004,Chap 88:561-9.
  4. Perinatal Morbidity report of the health care commuter expert panel on perinatal morbidity, National health and medical research Council. Australian government public service 1998.
  5. Shaywitz BA. Perinatal Asphyxia. In: MacMillan JA et al, Oski’s Pediatrics Principles and Practice: Lippincott Williams and Wilkins, 3rd ed 1999, Chap 34: 235-237
  6. Bader D, Gozal D, Weigner-Abend M, Berger A, Lanir A. Neonatal urinary uric acid/ creatinine ratio as an additional marker of perinatal asphyxia; Eur J Pediatr. 1999 Sep; 154 (9): 747-9.
  7. Perlman JM. Markers of asphyxia and neonatal brain injury; NEJM 1999 Jul; 341 (5); 361-5.
  8. Thornberg E, Thiringer K, Hagberg H, Kjellmer I. Neuron specific enolase in asphyxiated newborns: association with encephalopathy and cerebral function monitor trace. Arch Dis Child Fetal Neonatal, ed 1995 Jan; 72(1): F39-42.
  9. Martín-Ancel A, García-Alix A, Pascual-Salcedo D, Cabañas F, Valcarce M, and Quero J. Interleukin-6 in the Cerebrospinal Fluid After Perinatal Asphyxia Is Related to Early and Late Neurological Manifestations. Pediatrics, Novemeber 1997; 100(5): 789-794.
  10. Blennow M, Hagberg H, Rosengren L. Glial fibrillary acidic protein in the cerebrospinal fluid: a possible indicator of prognosis in full term asphyxiated newborn infants?. Pediatr Res, March 1995; 37 (3): 260-4.
  11. Huang CC, Wang ST, Chaochang Y, Lin KP, Pei- Linwu. Measurement of the urinary lactate: creatinine ratio for the early identification of newborn infants at risk for HIE. NEJM July 1999; 341 (5): 328-335.
  12. Akisu M, Kulturusay N. Value of the urinary uric acid to creatinine ratio in term infants with perinatal asphyxia. Acta Pediatr Jpn Feb 1998; 40(1): 78-81.
  13. Chen HJ, Tsai KS. Urinary uric acid to creatinine ratio as an additional marker of perinatal asphyxia. J Formos Med Assoc Oct 2000; 99(10): 771-4.
  14. Tekgul H, Yalaz M, Kutukculer N, Ozbek S, Kose T, Akisu M et al. Value of biochemical markers for outcome in term infants with asphyxia. Pediatr Neurol Nov 2004; 31(5): 326-332.

Corresponding Author

Manish Kumar 

Senior resident, Pediatric intensive care unit, Dept of pediatric, Dr RML Hospital, PGIMER

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