Can urinary excretion rate of malondialdehyde, uric acid and protein predict the severity and impending death in perinatal asphyxia?
BACKGROUND
Perinatal asphyxia (PA) associated with multi-organ damage is a leading cause of neonatal mortality and morbidity. We evaluated if urinary malondialdehyde:creatinine (UMDA:Cr), uric acid:creatinine (UUA:Cr) and protein:creatinine (UP:Cr) vary with the severity of PA and if these parameters can predict the impending death in PA.


METHODS
Study included 20 asphyxiated and 20 healthy newborn males. Hypoxic-ischemic encephalopathy (HIE) staging, APGAR (activity, pulse, grimace, appearance and respiration) score and urinary protein, uric acid, creatinine and MDA were evaluated.


RESULTS
UMDA:Cr, UUA:Cr and UP:Cr were significantly higher and correlated with APGAR and HIE in PA. By regression analysis also, urinary parameters were found to have significant association with HIE stage and APGAR in PA. Receiver operating characteristics (ROC) curve of UP:Cr, UUA:Cr and UMDA:Cr showed area under curve of 0.896 (p=0.003), 0.859 (p=0.008) and 0.849 (p=0.010) with cut-off value of 9.04 mg, 2.34 mg and 3.49 microg/mg of creatinine respectively that can optimally predict the impending death in PA. SDS-PAGE of unconcentrated urine detected both high (73 kDa and 68 kDa) and low molecular weight proteins (52 kDa, 47 kDa, 25 kDa and 20 kDa) in PA but not in controls.


CONCLUSIONS
Urinary excretion rate of uric acid, MDA and proteins is higher and has potential to act as biochemical markers for severity evaluation and death prediction in PA.
Banupriya
C
C
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Ratnakar
Doureradjou
P
P
Mondal
N
N
Vishnu
Bhat
B
Koner
B C
BC
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000401:mortality / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine; D004591:Electrophoresis, Polyacrylamide Gel; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008315:Malondialdehyde / Q000652:urine*; D018384:Oxidative Stress; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000652:urine*; D012720:Severity of Illness Index; D014527:Uric Acid / Q000652:urine*
D015415:Biomarkers; D014527:Uric Acid; D008315:Malondialdehyde; D003404:Creatinine