Urinary Uric Acid/Creatinine Ratio - A Marker for Birth Asphyxia

Abstract

Background: Perinatal hypoxia is one of the leading causes of perinatal mortality in developing countries. Despite the important advances in perinatal care in the past decades, Birth asphyxia remains a stubborn condition leading to significant mortality and morbidity. The present study was conducted to Assess the Urinary Uric Acid /Creatinine Ratio as a Marker For Birth Asphyxia In Comparison With Cord Blood ABG Analysis And Apgar Score Monitoring.
Material and methods: 68 term newborns among all the study group were divided into 2 groups of 34 birth asphyxia and 34 normal babies of whom umbilical cord arterial blood Ph, urinary uric acid and urinary creatinine levels and their ratio was compared.
Results: The mean gestational age among the Normal term newborns and term newborns with Birth Asphyxia was almost similar in both the groups. we assessed the modes of delivery among the term newborns with birth asphyxia and the normal term newborns.We observed that majority of the study subjects were delivered by normal delivery. Mean birth weight(kg) of cases(asphyxiated newborns) and controls(normal newborns) were compared and we did not find any statistically significant association. we assessed the APGAR SCORE among the term newborns with birth asphyxia and term normal newborns at 1 and 5 mins of life.
Mean APGAR at 1 minute and 5 minutes of cases was significantly lower than that of controls. Mean Cord Arterial Blood pH, pO2 of cases (asphyxiated group) was significantly lower than controls and pCO2 is observed to be higher than in controls(normal newborns). Mean Urinary uric acid and Mean Urinary Creatinine of cases (asphyxiated group) was higher than in controls(normal newborns).
In the present study In Asphyxiated and control group, mean urinary UA/Cr ratio was higher in asphyxiated group compared to controls(normal newborns) (2.65+/-0.53 VS 1.57+/-0.25). This is significant. The umbilical cord blood pH had significant positive correlation with 1st minute Apgar score, 5th minute Apgar, while urinary UA/Cr ratio had significant negative correlation with cord blood pH (r= -0.63, p=0.002). Urinary UA/Cr ratio with criterion of >2.3 had 88.24% sensitivity, 94.12% specificity with AUC of 0.971 (p<0.001) had a better predictive value.
Conclusion: Urinary UA/Cr ratio is an accessible, non-invasive, painless, cost-effective supportive framework with good predictive value for use as an additional marker for birth asphyxia.There exists still a need to study these parameters in the context of therapeutic hypothermia and how the parameters change over the period of treatment.