Presented at the Neonatal Society 2011 Spring Meeting.
Karlsson M3,4, Liu X1, Jary S1, Brown E1, Sabir H1, Stone J2, Cowan F5, Thoresen M6
1 School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
2 University Hospital Bristol, Department of Biochemistry, Bristol, United Kingdom
3 Department of Clinical Science and Education, Karolinska Institute at Stockholm Söder Hospital, Sweden
4 Department of Clinical research, Karlstad, Sweden
5 Department of Paediatrics, Imperial Collage, Hammersmith Hospital, London, United Kingdom
6 Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
Background: Lactate dehydrogenase (LDH) leakage due to hypoxia-ischemia induced cell damage is seen together with Hypoxic Ischemic Encephalopathy (HIE) in newborns (1). Early and easily accessible biomarkers that are not affected by hypothermia (HT) per see are needed for prediction of outcome after perinatal asphyxia (2). Therefore the aims of the study were to investigate whether plasma LDH activity within 72hrs post-partum predicts adverse outcome in term infants with moderate to severe HIE treated with hypothermia (HT) and whether LDH is a better predictor than pH at birth. We also investigated whether the LDH levels differed between acute and non-acute insults and postnatal collapse. The study was performed with ethical permission (CAS 09/H0106/64).
Methods: Plasma LDH activity was measured within 72h post partum in newborn infants treated with HT due to HIE (n=35) using entry-criteria as defined in the CoolCap trial (3). Adverse outcome was defined as a MDI; Mental Development Index<70 or Psychomotor Development Index PDI<70 on the Bayley Scales II score at 18months of age or death. The predictive value of the peak LDH activity for long term adverse outcome was assessed using a ROC curve.
Results: High predictive properties for LDH with an AUC (95 % CI) of 0.92 (0.82-1.00) vs. 0.55 (0.36-0.74) for pH. A significant difference in LDH@<6h after birth was seen between acute, non-acute insult and postnatal collapse (p=0.002).
Conclusion: This result is of clinical interest offering a potential inexpensive and safe predictor of brain injury in newborn infants treated with HT after HIE.
Corresponding author: marianne.thoresen@bristol.ac.uk
References
1. Karlsson, M., et al. Lactate dehydrogenase predicts hypoxic ischaemic encephalopathy in newborn infants: a preliminary study. Acta Paediatrica 2010 99:p.1139-44.
2. Thoresen, M., et al. “Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia.” Pediatrics 2010. 126: p131-9.7.
3. Gluckman, P., et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005.365: 663-70.