Journal de biologie néonatale

Abstrait

Prognostic Markers of Neonatal Outcomes in Full Term Neonates Suffering from Perinatal Asphyxia

Nadia S. O. Vargas, Maria Esther J. Ceccon, Mario CiceroFalcao and Werther B. De Carvalho

Abstract
Objective The aim of this study were, using only the score clinic of Sarnat and Sarnat, the blood markers of asphyxia that are routinely used in all hospitals of our country (Brazil) and the ultrasonography imaging method performed with 24 and 72 hours and 28 days of life, verify if these are sufficient to detect the neurological evolution of the patient.
Methods
The study was conducted with a prospective cohort of term newborns that suffering perinatal asphyxia by Buonocore criteria (2002). These criteria identify the level of the pH in cord blood that was collected of all newborns and also the blood markers: glutamic oxaloacetic transaminase, glutamic pyruvate transaminase, lactate dehydrogenase and creatine kinase (CKMB).These testes were collected at birth, with 24, 48 and 72 hours of life. The score clinical of Sarnat and Sarnat was performed with 24 hours, 48 hours and 72 hours of life and the ultrasound skull with 24, 48, 72 hours of life and in the end of neonatal period with 28 days of life. The period of study was one year.
Results
In the study´s period 2989 babies were born. The Buonocore criteria were found in 28 newborn showing a frequency of 1% of perinatal asphyxia. The marker of asphyxia were between the normal value of reference and only de iso-enzyme CKMB was a good marker, com value more than 5,10 ng/mL. The brain ultrasonography was altered with 72 hours of life, but one newborn presented alterations only with 28 days of life. The clinical examination using the clinical score of Sarnat and Sarnat demonstrated that 21,42% presented hypoxic-ischemic encephalopathy. In the ROC curve we observed sensitivity of 85,7%, specificity of 85,7% and accuracy of 85,7% correlated the value of CKMB and the brain ultrasonography of 72 hours of life. Conclusions
Perinatal asphyxia may be diagnosed in any hospital if the neonatologist or the neurologist apply the easy score clinical of Sarnat and Sarnat, the iso-enzime CKMB and the serial ultrasonography. In this study the worse alteration was with 72 hours of life, however we must be careful because in one neonate the alteration was present only with 28 days of life.