Use of serum levels of selected enzymes as a supportive tool in assessing severity of birth asphyxia in low resource setting

Abstract

Introduction: Severe birth asphyxia is one of the reasons why babies are admitted into the newborn unit and contributing significantly to neonatal morbidity and mortality. Hypoxic injury, when severe, leads to leakage of intracellular enzymes into the circulation. The level of these enzymes reflects the severity of the damage; this can identify babies with a severe injury, especially the out borns whose deliveries were not supervised. This study aimed to relate the serum levels of three enzymes at the age of twelve hours to the severity of birth asphyxia using the Apgar score and neurological state of the babies.
Methods: A prospective comparative cross-sectional study. Term babies with Apgar score ˂ 7 at 1- minute of life were recruited, scores of 0-3 were taken as severe birth asphyxia. Serum levels of lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase, were determined at the age of 12 hours using an ultraviolet spectrophotometer. Levels of the enzymes were related to the severity of birth asphyxia. SPSS for Windows, version 18 was used to analyse the data
Results: Seventy babies with birth asphyxia and 70 controls were studied. Fifteen (41.7%) of the 36 babies with severe birth asphyxia had hypoxic-ischemic encephalopathy, four (5.7%) of which died. The mean values of each of the enzymes were higher in babies with hypoxic-ischaemic encephalopathy than in those without (p = 0.001), and in babies that died than babies that survived (p = 0.001).
Conclusion: Estimation of these enzymes clearly defines the severity of hypoxic injury in babies with birth asphyxia. The estimation of these enzymes will be a useful tool in identifying babies with birth asphyxia especially in outborns whose deliveries were not supervised.
Keywords: Birth asphyxia, lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase.