Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Ontario, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa Ontario, Canada.
Sci Rep. 2019 Oct 31;9(1):15704. doi: 10.1038/s41598-019-51919-x.
Hypoxic ischemic encephalopathy (HIE) is a major cause of neonatal mortality and morbidity. Our study sought to examine whether patterns of newborn screening analytes differed between infants with and without neonatal HIE in order to identify opportunities for potential use of these analytes for diagnosis in routine clinical practice. We linked a population-based newborn screening registry with health databases to identify cases of HIE among term infants (≥37 weeks' gestation) in Ontario from 2010-2015. Correlations between HIE and screening analytes were examined using multivariable logistic regression models containing clinical factors and individual screening analytes (acyl-carnitines, amino acids, fetal-to-adult hemoglobin ratio, endocrine markers, and enzymes). Among 731,841 term infants, 3,010 were diagnosed with HIE during the neonatal period. Multivariable models indicated that clinical variables alone or in combination with hemoglobin values were not associated with HIE diagnosis. Although the model was improved after adding acyl-carnitines and amino acids, the ability of the model to identify infants with HIE was moderate. Our findings indicate that analytes associated with catabolic stress were altered in infants with HIE; however, future research is required to determine whether amino acid and acyl-carnitine profiles could hold clinical utility in the early diagnosis or clinical management of HIE. In particular, further research should examine whether cord blood analyses can be used to identify HIE within a clinically useful timeframe or to guide treatment and predict long-term health outcomes.
缺氧缺血性脑病（HIE）是新生儿死亡和发病的主要原因。我们的研究旨在检查新生儿筛查分析物的模式是否在患有和不患有新生儿 HIE 的婴儿之间存在差异，以便确定这些分析物是否有潜力在常规临床实践中用于诊断。我们将基于人群的新生儿筛查登记处与健康数据库联系起来，以确定 2010 年至 2015 年安大略省足月婴儿（≥37 周妊娠）的 HIE 病例。使用包含临床因素和单个筛查分析物（酰基辅酶 A、氨基酸、胎儿到成人血红蛋白比、内分泌标志物和酶）的多变量逻辑回归模型检查 HIE 与筛查分析物之间的相关性。在 731,841 名足月婴儿中，有 3,010 名在新生儿期被诊断患有 HIE。多变量模型表明，仅临床变量或与血红蛋白值组合在一起与 HIE 诊断无关。尽管在添加酰基辅酶 A 和氨基酸后模型得到了改善，但该模型识别 HIE 婴儿的能力仍为中等。我们的研究结果表明，与分解代谢应激相关的分析物在患有 HIE 的婴儿中发生了改变；然而，需要进一步的研究来确定氨基酸和酰基辅酶 A 谱是否在 HIE 的早期诊断或临床管理中具有临床实用性。特别是，进一步的研究应该检查脐带血分析是否可以在临床有用的时间范围内用于识别 HIE 或指导治疗和预测长期健康结果。
