Urine Uric Acid Creatinine Ratio as a Diagnostic and Prognostic Marker of Neonatal Birth Asphyxia

Urine Uric Acid Creatinine Ratio in Birth Asphyxia

Keywords: Apgar Score, Hypoxic-Ischemic Encephalopathy, Neonatal Depression, Umbilical Cord Blood pH

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.

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References

Millar LJ, Shi L, Hoerder-Suabedissen A, Molnár Z. Neonatal Hypoxia Ischaemia: Mechanisms, Models, and Therapeutic Challenges. Front Cell Neurosci. 2017;11:78. Available from: https://dx.doi.org/10.3389/fncel.2017.00078.

Odd D, Heep A, Luyt K, Draycott T. Hypoxic-ischemic brain injury: Planned delivery before intrapartum events. J Neonatal Perinatal Med. 2017;10(4):347–353. Available from: https://dx.doi.org/10.3233/npm-16152.

Bonifacio SL, Gonzalez F, Ferriero DM. Central nervous system injury and neuroprotection. In: CA G, SU D, editors. Avery’s disease of the newborn. Elsevier; 2012. p. 874–879.

Rich PR. The molecular machinery of Keilin’s respiratory chain. Biochem Soc Trans. 2003;31(6):1095–1105. Available from: https://dx.doi.org/10.1042/bst0311095.

Krishnana E, Ponnusamy V, Sekar SP. Study of urinary uric acid and creatinine ratio as a marker of neonatal asphyxia for babies born in a tertiary care hospital. Int J Res Med Sci. 2017;5(12):5418–5418. Available from: https://dx.doi.org/10.18203/2320-6012.ijrms20175466.

Use and abuse of the Apgar score. Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Pediatrics. 1996;98(1):141–142.

Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM. American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2015;13(2):196–218. Available from: https://dx.doi.org/10.1542/peds.2015-3373G.

Bhongir AV, Yakama A, Saha S, Radia SB, Pabbati J. The urine uric acid/creatinine ratio is an adjuvant marker for perinatal asphyxia. Eur J Pharm Med Res. 2015;2(5):520–528.

Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976;33(10):696–705. Available from: https://dx.doi.org/10.1001/archneur.1976.00500100030012.

Kumar DD, Chaudhari D, Kumar DA, Kamal DS. Urine uric acid and creatinine ratio as a marker of perinatal asphyxia. ISOR-J Dent Med Sci. 2016;15(6):13–15. Available from: https://dx.doi.org/10.7860/JCDR/2017/22697.9267.

Basu P, Som S, Choudhuri N, Das H. Correlation between Apgar score and urinary uric acid to creatinine ratio in perinatal asphyxia. Ind J Clin Biochem. 2008;23(4):361–364. Available from: https://dx.doi.org/10.1007/s12291-008-0079-2.

Palit S, Wilar R, Runtunuwu A, Lolombulan J. Blood pH and urinary uric acid-creatinine ratio in newborns with asphyxia. Paediatr Indones. 2016;55(6):352–352. Available from: https://dx.doi.org/10.14238/pi55.6.2015.352-6.

Choudhary L, Palsania S, Berwal PK, Sauparna C, Maheshwari

A. Study of Urinary Uric Acid and Creatinine Ratio as a Marker of Perinatal Asphyxia and Its Correlation with Different Stages of Hypoxic Ischemic Encephalopathy. Preg Child Health. 2017;04(03):12–18. Available from: https://dx.doi.org/10.4172/2376-127x.1000336.

Published
2020-07-09
How to Cite
Krishnan, A. R., Nayak, P., Bellipady, S. S., & Shenoy, R. D. (2020). Urine Uric Acid Creatinine Ratio as a Diagnostic and Prognostic Marker of Neonatal Birth Asphyxia. Asian Journal of Clinical Pediatrics and Neonatology, 8(2), 6-10. https://doi.org/10.47009/ajcpn.2020.8.2.2