Manalastas Maika, Shine Kailey C, Yuan Amy, Di Chiaro Bianca A, Weiss Marc G, Amin Sachin, Dina Pele, Muraskas Jonathan K
Loyola University Medical Center, USA.
Loyola University Stritch School of Medicine, USA.
Eur J Obstet Gynecol Reprod Biol X. 2023 Mar 30;18:100191. doi: 10.1016/j.eurox.2023.100191. eCollection 2023 Jun.
To investigate the rise and clearance of newborn creatinine in perinatal asphyxia as an adjunct biomarker to support or refute allegations of acute intrapartum asphyxia.
In this retrospective chart review, newborns > 35 weeks gestational age were evaluated from closed medicolegal cases of confirmed perinatal asphyxia and reviewed for causation. Data collected included newborn demographic data, patterns of hypoxic ischemic encephalopathy, brain magnetic resonance imaging, Apgar scores, cord and initial newborn blood gases, and serial newborn creatinine levels during the first 96 h of life. Newborn serum creatinine values were collected at 0-12, 13-24, 25-48, and 49-96 h. Newborn brain magnetic resonance imaging was used to define 3 patterns of asphyxial injury: acute profound, partial prolonged, or Both.
Two hundred and eleven cases of neonatal encephalopathy from multiple institutions were reviewed from 1987 to 2019 with only 76 cases having serial creatinine values during the first 96 h of life. A total of 187 creatinine values were collected. Partial prolonged and Both had significantly greater degree of metabolic acidosis in the first newborn arterial blood gas in comparison to acute profound. Acute profound and Both had significantly lower 5- and 10- minute Apgar scores in comparison to partial prolonged. Newborn creatinine values were stratified by asphyxial injury. Acute profound injury showed minimally elevated creatinine trends with rapid normalization. Partial prolonged and Both demonstrated higher creatinine trends with delayed normalization. Mean creatinine values were significantly different between the three types of asphyxial injuries within 13-24 h of life at the time when creatinine values peaked (p = 0.01).
Serial newborn serum creatinine levels taken within the first 96 h of life can provide objective data of timing and duration of perinatal asphyxia.
研究围产期窒息新生儿肌酐的升高及清除情况，作为辅助生物标志物以支持或反驳急性产时窒息的指控。
在这项回顾性病历审查中，对孕周>35周的新生儿进行评估，这些新生儿来自确诊围产期窒息的封闭法医学病例，并对病因进行审查。收集的数据包括新生儿人口统计学数据、缺氧缺血性脑病模式、脑磁共振成像、阿氏评分、脐带血和新生儿初始血气，以及出生后96小时内的系列新生儿肌酐水平。在0 - 12小时、13 - 24小时、25 - 48小时和49 - 96小时收集新生儿血清肌酐值。使用新生儿脑磁共振成像来定义3种窒息性损伤模式：急性重度、部分性延长或两者皆有。
回顾了1987年至2019年多个机构的211例新生儿脑病病例，其中只有76例在出生后96小时内有系列肌酐值。共收集到187个肌酐值。与急性重度相比，部分性延长和两者皆有的新生儿首次动脉血气中代谢性酸中毒程度明显更高。与部分性延长相比，急性重度和两者皆有的5分钟和10分钟阿氏评分明显更低。新生儿肌酐值按窒息性损伤分层。急性重度损伤显示肌酐略有升高趋势且迅速恢复正常。部分性延长和两者皆有则显示肌酐升高趋势较高且恢复正常延迟。在肌酐值达到峰值时，即出生后13 - 24小时内，三种窒息性损伤类型之间的平均肌酐值有显著差异（p = 0.01）。
出生后96小时内采集的系列新生儿血清肌酐水平可为围产期窒息的时间和持续时间提供客观数据。
