Serum and urinary uric acid and creatinine ratio as biomarker in perinatal asphyxia

Abstract

Background According to the WHO, the main cause of early neonatal mortality is perinatal asphyxia, which is defined as the inability to establish breathing at birth and is thought to be responsible for 900,000 fatalities annually.1 An estimated 23% of the 4 million neonatal deaths and 26% of the 3.2 million stillbirths that occur each year worldwide are thought to be caused by hypoxia that affects newborns (birth asphyxia) or foetus (fresh stillbirth). Newborns delivered intramurally can be considered asphyxiated if the APGAR score is less than 7 at birth. At 1 minute after birth, moderate birth asphyxia is defined as an APGAR score of four to six, while severe birth asphyxia is defined as an APGAR score of three or lower. Acute kidney injury occurs during moderate to severe Birth Asphyxia. Chronic renal insult may result from hypoxia, hypotension, and the use of nephrotoxic drugs both during pregnancy and after delivery. The most prevalent of the recognized consequences is Acute Renal Failure (ARF), which has a poor prognosis and can cause irreversible renal impairment in as many as 40% of survivors10. Most of the studies on acute kidney injury following perinatal asphyxia focus only on Urinary uric acid and creatinine ratio. The ratio of serum Uric acid to creatinine as a biomarker for prenatal hypoxia has not been the subject of any published research. Ours is the first research of its type. To determine the severity of hypoxia and its result, the study must correlate maternal variables with neonatal resuscitation level, serum creatinine, and uric acid level in resuscitated neonates. Aims & Objectives: 1. To determine serum uric acid and creatinine levels and urinary uric acid and creatinine levels in neonates with perinatal asphyxia and try to correlate them. 2. To compare the extent of Renal injury with the severity of asphyxia and the level of resuscitation done at birth. Results: A total of 68 cases and 61 controls were analyzed. Most of the infants in the case groups were male, comprising 64.7% (n=44). Among the cases, 36.8% (n=25) underwent lower-segment cesarean section (LSCS), while 63.2% (n=43) had a vaginal delivery, out of which 58.1%(n=25) were primigravida and 41.8%(n=18). At an APGAR score of 5 min, 10.2% (n=7) had an APGAR score of 0-3, while 41.1% (n=28) had an APGAR score between 4-6, and later, 48.5% (n=33) had an APGAR score greater than 7. There is an association between renal parameters and APGAR score at 5 min and found that there is a statistical significance between all these after applying the chi-square test (p-value <0.01) Conclusion: This study shows that serum and urinary uric acid and creatinine ratios have potential as biomarkers for perinatal asphyxia. There’s an important link between these biochemical markers and low APGAR scores, which supports their role in early diagnosis.