Department of Neonatology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University, Xi'an, China.
Neonatology. 2010;97(1):41-4. doi: 10.1159/000227292. Epub 2009 Jul 7.
Early identification and prevention of hypoxic-ischemic encephalopathy (HIE) in newborns may reduce neonatal mortality and neurological dysfunction.
To analyze the diagnostic and prognostic values of urinary S100B level and lactate/creatinine ratio in newborns with HIE.
Seventy-eight full-term newborns with HIE and 25 normal newborns were enrolled. The Neonatal Behavioral Neurological Assessment (NBNA) and Developmental Screening Test were scored. The concentration of urinary S100B protein was determined using the S100B enzyme-linked immunosorbent assay and the levels of urinary lactate and creatinine were measured with the enzyme colorimetric method.
Urinary S100B level on days 1-3 after birth and lactate/creatinine ratio on day 1 were significantly higher in newborns with HIE than those in the control group. Both indexes were positively correlated with the clinical grading of HIE. A cutoff value for the S100B level of 0.47 microg/l on day 3 after birth had a sensitivity of 90% and specificity of 92% for prediction of HIE. A lactate/creatinine ratio of more than 0.55 on day 1 showed the highest sensitivity (92%) and specificity (90%). A combination of both indexes improved the sensitivity and specificity to 99 and 97%, respectively. A negative correlation of both lactate/creatinine ratio on day 1 and S100B level on days 1-3 after birth with the NBNA score was identified on days 3, 7 and 14 after birth. The Developmental Screening Test score of 36 newborns with HIE within 6 months after birth showed that 65% of infants with moderate and high HIE had an abnormal developmental quotient.
These data suggest that early measurement of both S100B level and lactate/creatinine ratio in the urine of newborns with HIE is a practical convenient and sensitive way to improve diagnosis on the third day of life and prognostic prediction of HIE.
早期识别和预防新生儿缺氧缺血性脑病（HIE）可能降低新生儿死亡率和神经功能障碍。
分析尿 S100B 水平和乳酸/肌酐比值在新生儿缺氧缺血性脑病中的诊断和预后价值。
纳入 78 例足月新生儿缺氧缺血性脑病患儿和 25 例正常新生儿。采用新生儿行为神经评估（NBNA）和发育筛查试验进行评分。采用 S100B 酶联免疫吸附试验测定尿 S100B 蛋白浓度，酶比色法测定尿乳酸和肌酐水平。
出生后 1-3 天尿 S100B 水平和第 1 天的乳酸/肌酐比值在 HIE 组明显高于对照组。两个指标均与 HIE 的临床分级呈正相关。出生后第 3 天 S100B 水平的截断值为 0.47μg/l，对 HIE 的预测敏感性为 90%，特异性为 92%。第 1 天乳酸/肌酐比值大于 0.55，敏感性最高（92%），特异性（90%）最高。两项指标联合应用可将敏感性和特异性分别提高至 99%和 97%。出生后第 1 天的乳酸/肌酐比值和出生后 1-3 天的 S100B 水平与 NBNA 评分呈负相关。6 个月后，36 例 HIE 新生儿的发育筛查试验评分显示，65%的中重度 HIE 患儿发育商异常。
这些数据表明，早期检测 HIE 新生儿尿中 S100B 水平和乳酸/肌酐比值是提高第 3 天诊断和 HIE 预后预测的实用、方便、敏感的方法。
