Iheji Chukwunonso Chigozie, Asinobi Isaac Nwabueze, Ndu Ikenna Kingsley, Ikefuna Anthony Nnaemeka
Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria.
Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria.
BMC Pediatr. 2025 Aug 5;25(1):599. doi: 10.1186/s12887-025-05981-2.
The lack of simple but effective and affordable diagnostic tools presents a challenge for the management of perinatal asphyxia, especially in low- to middle-income countries. Current diagnostic tools, such as arterial blood gas estimation, are expensive and not readily available at primary and secondary levels of care, where most cases of perinatal asphyxia are identified. This causes a delay in diagnosis. Perinatal asphyxia may have improved outcomes if there are cheaper, reliable, and more convenient diagnostic biomarkers that can aid early diagnosis leading to early initiation of treatment. This study assessed the utility of the urinary uric acid-to-urinary creatinine (UUA/UC) ratio in the diagnosis of perinatal asphyxia.
This study was conducted among 90 term newborns aged less than 24-hours delivered at delivered at the Enugu State University Teaching Hospital (ESUTH). In the study population, there were an equal number of asphyxiated and apparently healthy babies. Relevant maternal and neonatal histories were obtained, and physical examination was carried out for all enrolled newborns. Umbilical arterial blood was collected for blood gas analysis, and spot urine samples were collected and sent for uric acid and creatinine estimation. Relevant statistical tests were applied in the data analysis.
The mean UUA/UC ratio was significantly greater in the asphyxiated group (2.41 ± 0.73) than among the control group (0.87 ± 0.29) (t = 13.129, p < 0.001). The accuracy of the UUA/UC ratio in diagnosing perinatal asphyxia had an area under the curve (AUC) of 0.978, implying that the test is accurate. The cut-off point that gives the best diagnosis of perinatal asphyxia was 1.54, with a sensitivity of 95.6%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 96%. Additionally, the UUA/UC ratio has a very strong positive correlation with the severity of hypoxic-ischaemic encephalopathy (HIE) (r = 0.843, p < 0.001).
The UUA/UC ratio is a good diagnostic marker of asphyxia and varies with the severity of encephalopathy. Accordingly, the urinary uric acid-to-creatinine ratio is recommended as a surrogate biomarker for the diagnosis of perinatal asphyxia.
缺乏简单、有效且经济实惠的诊断工具给围产期窒息的管理带来了挑战，尤其是在低收入和中等收入国家。当前的诊断工具，如动脉血气分析，价格昂贵，在大多数围产期窒息病例得以确诊的初级和二级医疗保健机构中并不容易获得。这导致诊断延迟。如果有更便宜、可靠且更便捷的诊断生物标志物能够辅助早期诊断并促使尽早开始治疗，围产期窒息的预后可能会得到改善。本研究评估了尿尿酸与尿肌酐（UUA/UC）比值在围产期窒息诊断中的效用。
本研究在埃努古州立大学教学医院（ESUTH）分娩的90例出生未满24小时的足月儿中进行。在研究人群中，窒息婴儿和外观健康的婴儿数量相等。获取了相关的母亲和新生儿病史，并对所有纳入研究的新生儿进行了体格检查。采集脐动脉血进行血气分析，同时采集随机尿样并送去检测尿酸和肌酐水平。数据分析中应用了相关的统计学检验。
窒息组的平均UUA/UC比值（2.41±0.73）显著高于对照组（0.87±0.29）（t = 13.129，p < 0.001）。UUA/UC比值诊断围产期窒息的曲线下面积（AUC）为0.978，这意味着该检测方法准确。诊断围产期窒息的最佳截断点为1.54，灵敏度为95.6%，特异度为100%，阳性预测值为100%，阴性预测值为96%。此外，UUA/UC比值与缺氧缺血性脑病（HIE）的严重程度具有非常强的正相关性（r = 0.843，p < 0.001）。
UUA/UC比值是窒息的良好诊断标志物，且随脑病严重程度而变化。因此，建议将尿尿酸与肌酐比值作为围产期窒息诊断的替代生物标志物。
