THE PREDICTIVE VALUE OF ELEVATION IN SPECIFIC SERUM ENZYMES FOR SUBSEQUENT DEVELOPMENT OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY OR INTRAVENTRICULAR HEMORRHAGE IN FULL-TERM AND PREMATURE ASPHYXIATED NEWBORNS

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 ap proach of the present study nias to evaluate firstly if serum levels o f these enzymes correlate with the development of hypoxic-ischemic enc ephalopathy (HIE) and periventricular-intraventricular hemorrhage (PIV H) in full-term and premature asphyxiated newborns, and secondly if po stnatally elevated enzyme activities could be predictive for these dis orders. ASAT, LDH and HBDH activities were measured in 98 asphyxiated newborns. Blood samples were taken serially at five fixed times: 0 (co rd), 12, 24, 72, and 144 hours post partum. AU 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/pre mature, 7/12). The full-term asphyxiated newborns with HIE or PIVH sho wed significantly elevated ASAT, LDH, and HBDH activities within the f irst. 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 (71.0%/88.1%), an acceptable nega tive predictive value (44.9%/50.0%), and a high positive predictive va lue (96.5%/94.9%) for the development of HIE and PIVH in full-term asp hyxiated 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 enzy mes is elevated within the first 24 hours of life, the later developme nt of HIE or PIVH should be anticipated.