title: Urinary Uric Acid/Creatinine Ratio - A Marker For Perinatal Asphyxia.
abstract: BACKGROUND
  Perinatal hypoxia is one of the leading causes of perinatal mortality in developing countries. Both apgar score and arterial blood pH predict the neonatal mortality in asphyxia. Apgar score alone does not predict neurologic outcome and as it is influenced by various factors. This study was conducted to evaluate the utility and sensitivity of urinary uric acid to creatinine ratio (UA/Cr ratio) in asphyxia diagnosis, compared to invasive Arterial Blood Gas (ABG) analysis.
  
  
  OBJECTIVE
  To assess the urinary uric acid/creatinine ratio as an additional marker for perinatal asphyxia compared with ABG analysis in apgar score monitoring.
  
  
  METHODS
  The present case control study was conducted at a teaching hospital in Central Gujarat. Data of 40 healthy newborns and 40 asphyxiated newborns were collected. In absence of regional estimates, a sample of size 39 was required to attain a power of 80% at 5% alpha (type I error) considering a moderate effect size of 0.65. (UA/Cr) ratio was measured from the spot urine sample collected during 24-72 hours of birth. Statistical analysis was performed by Independent t-test, Pearson's correlation coefficient (r) and Receiver Operating Characteristic (ROC) plots.
  
  
  RESULTS
  The mean (UA/Cr ratio) (2.75±0.18 vs 1.78±0.23) is significantly higher in asphyxiated group than in the control group (p<0.0001). Urinary UA/Cr ratio had negative correlation with blood pH (r= -0.27, p=0.18), which was not significant (p>0.05). Urinary UA/Cr ratio with criterion of >2.3 had 100% sensitivity, 100% specificity with AUC of 1 (p<0.0001) had a better predictive value.
  
  
  CONCLUSIONS
  Apgar score is usually reduced in neonates with congenital anomalies and premature neonates. Hence, it is preferable that the clinical diagnosis of asphyxia by apgar scores be supported by other investigations so that early decision can be taken about the level of care the baby needs. pH, lactates and base deficits change with establishment of respiration following resuscitation. However, pH, lactate, base deficit estimations are invasive and need rapid estimations. Non-invasive urinary UA/Cr ratio may be an answer to these issues as it easy, economical and equally efficient.
authors.affiliation: Resident, Department of Biochemistry, Pramukhswami Medical College , Karamsad, Gujarat, India .
authors.forename: Kinjal Prahaladbhai
authors.initials: KP
authors.lastname: Patel
authors.affiliation: Resident, Department of Biochemistry, Pramukhswami Medical College , Karamsad, Gujarat, India .
authors.forename: Mayur Goradhanbhai
authors.initials: MG
authors.lastname: Makadia
authors.affiliation: Resident, Department of Biochemistry, Pramukhswami Medical College , Karamsad, Gujarat, India .
authors.forename: Vishwal Indravardan
authors.initials: VI
authors.lastname: Patel
authors.affiliation: Professor, Department of Biochemistry, Pramukhswami Medical College , Karamsad, Gujarat, India .
authors.forename: Haridas Neelakandan
authors.initials: HN
authors.lastname: Nilayangode
authors.affiliation: Professor, Department of Paediatrics, Pramukhswami Medical College , Karamsad, Gujarat, India .
authors.forename: Somashekhar Marutirao
authors.initials: SM
authors.lastname: Nimbalkar
keywords: Asphyxia markers; Hypoxic-ischemic encephalopathy; Neonatal mortality