Abstract
Serum lactate dehydrogenase (LDH), aspartate aminotransferase (ASAT), and hydroxybutyrate
dehydrogenase (HBDH) activities are significantly elevated in asphyxiated newborns
within the first days of life. The approach of the present study was to evaluate firstly
if serum levels of these enzymes correlate with the development of hypoxic-ischemic
encephalopathy (HIE) and periventricular-intraventricular hemorrhage (PIVH) in full-term
and premature asphyxiated newborns, and secondly if postnatally elevated enzyme activities
could be predictive for these disorders.
ASAT, LDH and HBDH activities were measured in 98 asphyxiated newborns. Blood samples
were taken serially at five fixed times: 0 (cord), 12, 24, 72, and 144 hours post
partum. All newborns were examined for the development of HIE and PIVH using standardized
scoring systems. Fifty percent of the newborns were full-term and 50 % were premature.
Ten of the full-term (20.4 %) and 21 (42.8 %) of the premature newborns developed
HIE. Nineteen newborns (19.4 %) suffered PIVH (full-term/premature, 7/12). The full-term
asphyxiated newborns with HIE or PIVH showed significantly elevated ASAT, LDH, and
HBDH activities within the first 72 hours of life. In case of the premature asphyxiated
newborns, the enzyme activities did not differ significantly between the study groups.
The overall predictive values showed a high sensitivity (HIE/ PIVH, 90.0 %/71.4 %),
a high specifity (71.096/88.1 %), an acceptable negative predictive value (44.9 %/50.0
%), and a high positive predictive value (96.5 %/94.9 %) for the development of HIE
and PIVH in full-term asphyxiated newborns.
It is concluded that measurements of ASAT, LDH, and HBDH activities are reliable predictors
for the development of HIE and PIVH in full-term asphyxiated newborns. If at least
one of these enzymes is elevated within the first 24 hours of life, the later development
of HIE or PIVH should be anticipated.
Key words
Preterm neonates - Full-term neonates - Perinatal asphyxia - Hypoxic-ischemic encephalopathy
- Periventricular-intraventricular hemorrhage - Serum enzyme measurements
