Evaluation of urinary S100B protein level and lactate/creatinine ratio for early diagnosis and prognostic prediction of neonatal hypoxic-ischemic encephalopathy.
BACKGROUND
Early identification and prevention of hypoxic-ischemic encephalopathy (HIE) in newborns may reduce neonatal mortality and neurological dysfunction.


OBJECTIVE
To analyze the diagnostic and prognostic values of urinary S100B level and lactate/creatinine ratio in newborns with HIE.


METHODS
Seventy-eight full-term newborns with HIE and 25 normal newborns were enrolled. The Neonatal Behavioral Neurological Assessment (NBNA) and Developmental Screening Test were scored. The concentration of urinary S100B protein was determined using the S100B enzyme-linked immunosorbent assay and the levels of urinary lactate and creatinine were measured with the enzyme colorimetric method.


RESULTS
Urinary S100B level on days 1-3 after birth and lactate/creatinine ratio on day 1 were significantly higher in newborns with HIE than those in the control group. Both indexes were positively correlated with the clinical grading of HIE. A cutoff value for the S100B level of 0.47 microg/l on day 3 after birth had a sensitivity of 90% and specificity of 92% for prediction of HIE. A lactate/creatinine ratio of more than 0.55 on day 1 showed the highest sensitivity (92%) and specificity (90%). A combination of both indexes improved the sensitivity and specificity to 99 and 97%, respectively. A negative correlation of both lactate/creatinine ratio on day 1 and S100B level on days 1-3 after birth with the NBNA score was identified on days 3, 7 and 14 after birth. The Developmental Screening Test score of 36 newborns with HIE within 6 months after birth showed that 65% of infants with moderate and high HIE had an abnormal developmental quotient.


CONCLUSIONS
These data suggest that early measurement of both S100B level and lactate/creatinine ratio in the urine of newborns with HIE is a practical convenient and sensitive way to improve diagnosis on the third day of life and prognostic prediction of HIE.
Liu
Li
L
Department of Neonatology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University, Xi'an, China. nellie918@yahoo.com.cn
Zheng
Chong-Xun
CX
Peng
Shu-Feng
SF
Zhou
Hong-Yan
HY
Su
Zu-You
ZY
He
Li
L
Ai
Ting
T
D001238:Asphyxia Neonatorum / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D015415:Biomarkers; D002657:Child Development; D003404:Creatinine / Q000652:urine*; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D018730:Infant Behavior; D007231:Infant, Newborn; D019344:Lactic Acid / Q000652:urine*; D009414:Nerve Growth Factors / Q000652:urine*; D011379:Prognosis; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000652:urine*
D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D019344:Lactic Acid; D003404:Creatinine