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Bellieni CV, Tomasini B, Bracciali C, Buonocore G. Normal values of creatine kinase and of MB-creatine kinase at birth in healthy babies. Minerva Pediatr (Torino) 2023; 75:21-25. [PMID: 28425689 DOI: 10.23736/s2724-5276.17.04852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Today, few studies have been accomplished in order to determine serum creatine kinase (CK) activity in newborns by considering small groups of babies and without taking into account gestational age (GA) differences. Some authors have demonstrated that neonatal CK activity value at birth is higher than the normal range of CK activity considering for adults or older children. The objective of this study is to assess normal values of CK and MB-CK in neonatal blood, according to babies' GA. METHODS We retrieved the clinical files of 140 babies admitted into Siena Hospital NICU in a 2-years period, when CK was assessed routinely to all babies at birth. We selected files from 114 newborns and we divided the cohort into group A (non-stressed; N.=41) and group B (stressed; N.=73) on the basis of Apgar Score and signs of neurological lesions. We compared CK and MB-CK values in the two groups according to GA. RESULTS Mean CK value of the 41 non-stressed babies' samples: 413 IU/L (232 SD). CK significantly increases with GA. No differences are present in total CK activity between stressed vs. non-stressed babies; but a significant difference appears in these two groups for MB-CK (mean values: 456 vs. 175 IU/L). CONCLUSIONS This is the first study that compares CK and MB-CK values at birth according to the GA of the babies. CK values increase with GA, and stressed babies have higher MB-CK values than the non-stressed babies. These reference values are important for clinical practice.
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Affiliation(s)
- Carlo V Bellieni
- Neonatal Intensive Care Unit, University Hospital of Siena, Siena, Italy
| | - Barbara Tomasini
- Neonatal Intensive Care Unit, University Hospital of Siena, Siena, Italy
| | - Carlotta Bracciali
- Department of Molecular and Developmental Medicine, Le Scotte Polyclinic, University of Siena, Siena, Italy -
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, Le Scotte Polyclinic, University of Siena, Siena, Italy
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Garcia-Alix A, Arnaez J. Value of brain damage biomarkers in cerebrospinal fluid in neonates with hypoxic-ischemic brain injury. Biomark Med 2022; 16:117-125. [PMID: 35081738 DOI: 10.2217/bmm-2021-0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypoxic-ischemic encephalopathy is one of the leading causes of death and neurological disability worldwide. A key issue in neonates with hypoxic-ischemic encephalopathy is accurately establishing the occurrence and severity of brain lesions soon after a perinatal hypoxic-ischemic event. This is crucial to help with prognosis; guide clinical decision-making, including the use of other therapies; and improve family counseling. Neurobiochemical markers may offer a quantitative approximation for estimating the severity of brain damage and identifying infants who have a high risk of further neurological disability. In addition, they should help identify those neonates who would benefit most from the implementation of other neuroprotective and neuroreparative interventions. Despite considerable progress in this area, relatively few studies have been aimed at examining the clinical utility of brain-specific proteins in cerebrospinal fluid, an important opening to characterizing pathological phenomena associated with hypoxic-ischemic brain injury.
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Affiliation(s)
| | - Juan Arnaez
- Neonatal Neurology, NeNe Foundation, Madrid, 28010, Spain
- Hospital Universitario de Burgos, Burgos 09006, Spain. Neonatal Neurology, NeNe Foundation, Madrid, 28010, Spain
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Alkholy UM, Abdalmonem N, Zaki A, Ali YF, Mohamed SA, Abdelsalam NI, Hashim MIA, Sekkien MA, Elsherbiny YM. Early predictors of brain damage in full-term newborns with hypoxic ischemic encephalopathy. Neuropsychiatr Dis Treat 2017; 13:2133-2139. [PMID: 28860770 PMCID: PMC5558899 DOI: 10.2147/ndt.s144225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE OF THE STUDY To evaluate the value of serum creatine phosphokinase-brain specific (CK-BB) and urinary lactate/creatinine (L/C) ratio as early indicators of brain damage in full-term newborns with hypoxic ischemic encephalopathy (HIE). PATIENTS AND METHODS A case-control study including 25 full-term new-born infants with perinatal asphyxia who were admitted to neonatal intensive care unit (NICU) with a proven diagnosis of HIE, compared to 20 healthy age- and sex-matched full-term newborns. All newborn infants were subjected to full history taking, clinical examination, routine investigations (cord blood gases and complete blood picture), and assessment of serum CK-BB (cord blood, 6 and 24 hours after birth) and urinary L/C ratio (collected within the first 6 hours, on the 2nd and 3rd day after birth). RESULTS The serum CK-BB and urinary L/C ratio in infants with HIE were significantly higher in samples collected throughout the monitoring period when compared with the control group (all P<0.001). The cord CK-BB and urinary L/C ratio within the first 6 hours were significantly higher in infants with severe HIE than in infants with mild and moderate HIE (P<0.001). Cord CK-BB level at 12.5 U/L had 100% sensitivity and 84% specificity in the detection of severe HIE infants. Urinary L/C ratio of more than 10.5 collected within the first 6 hours after birth had 100% sensitivity and 78% specificity for the detection of severe HIE infants. CONCLUSION The serum CK-BB and urinary L/C ratio in HIE infants were significantly increased early in the course of the disease, which can be used as useful indicators for predicting the development of HIE.
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Affiliation(s)
| | | | - Ahmed Zaki
- Pediatric Department, Mansoura University, Egypt
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Lv H, Wang Q, Wu S, Yang L, Ren P, Yang Y, Gao J, Li L. Neonatal hypoxic ischemic encephalopathy-related biomarkers in serum and cerebrospinal fluid. Clin Chim Acta 2015; 450:282-97. [PMID: 26320853 DOI: 10.1016/j.cca.2015.08.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 12/15/2022]
Abstract
Neonatal hypoxic ischemic encephalopathy (HIE) is a common disease caused by perinatal asphyxia, a major cause of neonatal death, neurological behavior, and long-term disability. Currently, the diagnosis and prognosis of neonatal HIE are based on nervous system clinical manifestations, imaging and electrophysiological examination. These take time and late diagnosis allows brain injury to occur in newborns, so that infants of many brain injury missed the best treatment time, left with varying degrees of neurological sequelae. The use of biomarkers to monitor brain injury and evaluate neuroprotective effects might allow the early intervention and treatment of neonatal HIE to reduce mortality rates. This study reviewed the mechanism of neonatal hypoxic ischemic encephalopathy in relation to numerous brain-related biomarkers including NSE, S-100β, GFAP, UCH-L1, Tau protein, miRNA, LDH, and CK-BB. In early diagnosis of neonatal HIE, S-100β and activin A seems to be better biomarkers. Biomarkers with the greatest potential to predict long-term neurologic handicap of neonates with HIE are GFAP and UCH-L1 and when combined with other markers or brain imaging can increase the detection rate of HIE. Tau protein is a unique biological component of nervous tissues, and might have value for neonatal HIE diagnosis. Combination of more than two biological markers should be a future research direction.
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Affiliation(s)
- Hongyan Lv
- Department of Neonatology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China; Department of Neonatal pathology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China
| | - Qiuli Wang
- Department of Neonatology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China
| | - Sujing Wu
- Department of Neonatology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China; Department of Neonatal pathology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China
| | - Lihong Yang
- Department of Neonatology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China
| | - Pengshun Ren
- Department of Neonatology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China
| | - Yihui Yang
- Department of Neural development and neural pathology, Hebei University of Engineering School of Medicine, Handan 056029, Hebei Province, PR China
| | - Jinsheng Gao
- Department of Pathology, Hebei University of Engineering School of Medicine, Handan 056029, Hebei Province, PR China
| | - Lianxiang Li
- Department of Neonatal pathology, Handan Maternal and Child Care Centers, Handan 056002, Hebei Province, PR China; Department of Neural development and neural pathology, Hebei University of Engineering School of Medicine, Handan 056029, Hebei Province, PR China.
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Use of early biomarkers in neonatal brain damage and sepsis: state of the art and future perspectives. BIOMED RESEARCH INTERNATIONAL 2015; 2015:253520. [PMID: 25685774 PMCID: PMC4313065 DOI: 10.1155/2015/253520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/11/2014] [Indexed: 12/19/2022]
Abstract
The identification of early noninvasive biochemical markers of disease is a crucial issue of the current scientific research, particularly during the first period of life, since it could provide useful and precocious diagnostic information when clinical and radiological signs are still silent. The ideal biomarker should be practical and sensitive in the precocious identification of at risk patients. An earlier diagnosis may lead to a larger therapeutic window and improve neonatal outcome. Brain damage and sepsis are common causes of severe morbidity with poor outcome and mortality during the perinatal period. A large number of potential biomarkers, including neuroproteins, calcium binding proteins, enzymes, oxidative stress markers, vasoactive agents, and inflammatory mediators, have been so far investigated. The aim of the present review was to provide a brief overview of some of the more commonly investigated biomarkers used in case of neonatal brain damage and sepsis.
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Yamamoto Y, Ibara S, Tokuhisa T, Hirakawa E, Yoneda S, Kobayashi K, Kato E, Maruyama Y, Maede Y, Kuwabara T. Calcium concentration in hypoxic-ischemic encephalopathy during hypothermia. Pediatr Int 2015; 57:64-7. [PMID: 25287276 DOI: 10.1111/ped.12438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/22/2014] [Accepted: 06/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between prognosis and the changes in serum-ionized calcium concentration in neonates with hypoxic-ischemic encephalopathy (HIE) before and during brain hypothermia (BHT). METHODS Serum samples were obtained from 16 HIE neonates who underwent BHT. All patients underwent developmental testing at 18 months of age. RESULTS Mean serum-ionized calcium concentration in the poor outcome group (developmental quotient [DQ], <80; nine infants) was significantly lower than in the good outcome group (DQ >80; seven infants), both immediately before and after 6 h of BHT. Mean serum-ionized calcium concentration significantly decreased in both groups for 6 h, and the lowest adjusted serum-ionized calcium during 6 h of BHT was <1.05 mmol/L, known as the cut-off value for poor outcome, in 57.1% of the good outcome group. CONCLUSION The influx of calcium into cells continues regardless of neurological prognosis during the early phase of BHT, but BHT might protect some high-risk patients against neurological damage at low adjusted serum-ionized calcium concentration.
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Affiliation(s)
- Yutaka Yamamoto
- Department of Neonatology, Gifu Prefectural General Medical Center, Gifu, Japan; Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan; Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
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Nagdyman N, Grimmer I, Scholz T, Muller C, Obladen M. Predictive value of brain-specific proteins in serum for neurodevelopmental outcome after birth asphyxia. Pediatr Res 2003; 54:270-5. [PMID: 12736385 DOI: 10.1203/01.pdr.0000072518.98189.a0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Brain-specific proteins have been used to detect cerebral injury after birth asphyxia. Previous investigations suggest that serum protein S-100beta, brain-specific creatine kinase (CK-BB), and neuron-specific enolase (NSE) are capable of identifying patients with a risk of developing hypoxic-ischemic encephalopathy. Whether detection of elevated serum concentrations of these proteins reflects long-term neurodevelopmental impairment remains to be investigated. We examined serum protein S-100beta, NSE, and CK-BB at 2, 6, 12, and 24 h after birth in 29 asphyxiated infants and 20 control infants. Neurodevelopmental follow-up examinations were performed at 20 mo of age using the German revision of the Griffiths scales for developmental assessment. Elevated concentrations of serum protein S-100beta, NSE, and CK-BB within 24 h after asphyxia did not correlate with long-term neurodevelopmental delay. We conclude that serum protein S-100beta, NSE, and CK-BB, sampled on the first day of life, is of limited value in predicting severe brain damage after birth asphyxia.
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Affiliation(s)
- Nicole Nagdyman
- Department of Neonatology, Charité Virchow University Hospital, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Nagdyman N, Kömen W, Ko HK, Müller C, Obladen M. Early biochemical indicators of hypoxic-ischemic encephalopathy after birth asphyxia. Pediatr Res 2001; 49:502-6. [PMID: 11264433 DOI: 10.1203/00006450-200104000-00011] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia is a condition in which serum concentrations of brain-specific biochemical markers may be elevated. Neuroprotective interventions in asphyxiated newborns require early indicators of brain damage to initiate therapy. We examined brain-specific creatine kinase (CK-BB), protein S-100, and neuron-specific enolase in cord blood and 2, 6, 12, and 24 h after birth in 29 asphyxiated and 20 control infants. At 2 h after birth, median (quartiles) serum CK-BB concentration was 10.0 U/L (6.0-13.0 U/L) in control infants, 16.0 U/L (13.0-23.5 U/L) in infants with no or mild HIE, and 46.5 U/L (21.4-83.0 U/L) in infants with moderate or severe HIE. Serum protein S-100 was 1.6 microg/L (1.4-2.5 microg/L) in control infants, 2.9 microg/L (1.8-4.7 microg/L) in asphyxiated infants with no or mild HIE, and 17.0 microg/L (3.2-34.1 microg/L) in infants with moderate or severe HIE 2 h after birth. No significant difference was detectable in serum neuron-specific enolase between infants with no or mild and moderate or severe HIE 2 and 6 h after birth. A combination of serum protein S-100 (cutoff value, 8.5 microg/L) and CK-BB (cutoff value, 18.8 U/L) 2 h after birth had the highest predictive value (83%) and specificity (95%) of predicting moderate and severe HIE. Cord blood pH (cutoff value, <6.9) and cord blood base deficit (cutoff value, >17 mM) increase the predictive values of protein S-100 and CK-BB. We conclude that elevated serum concentrations of protein S-100 and CK-BB reliably indicate moderate and severe HIE as early as 2 h after birth.
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Affiliation(s)
- N Nagdyman
- Department of Neonatology, Institute of Laboratory Medicine, Charité University Hospital, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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9
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Sweet DG, Bell AH, McClure G, Wallace IJ, Shields MD. Comparison between creatine kinase brain isoenzyme (CKBB) activity and Sarnat score for prediction of adverse outcome following perinatal asphyxia. J Perinat Med 2000; 27:478-83. [PMID: 10732307 DOI: 10.1515/jpm.1999.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To assess whether plasma creatine kinase brain isoenzyme (CKBB) levels or Sarnat scores are more accurate for prediction of poor neurological outcome in babies with suspected birth asphyxia. METHODS In a retrospective study of 97 babies CKBB levels were compared to the presence of severe hypoxic ischaemic encephalopathy (HIE) as a predictive test for these outcomes: developmental delay, cerebral palsy, visual problems, deafness or death from perinatal asphyxia. The tests were compared using positive predictive values (PPV) and likelihood ratios (LR) with confidence intervals (CI). RESULTS 3 babies had died from perinatal asphyxia and 14 survivors were found to have neurological or developmental problems. CKBB was elevated in babies with severe HIE (p = 0.0004). A receiver operator characteristic (ROC) curve showed the optimal discriminating value for CKBB to be 21 IU/L but the CKBB was a poor predictive test. For prediction of adverse outcome: CKBB > 21 sensitivity 76%, specificity 40%, PPV 21% and LR 1.3 (95% CI 0.8-1.7). Severe HIE sensitivity 53%, specificity 95%, PPV 69% and LR 10.6 (95% CI 3.8-29.2). CONCLUSION CKBB is elevated following birth asphyxia but is a poor predictor of adverse neurological outcome.
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Affiliation(s)
- D G Sweet
- Royal Maternity Hospital Neonatal Unit, Queen's University of Belfast, Northern Ireland.
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van de Riet JE, Vandenbussche FP, Le Cessie S, Keirse MJ. Newborn assessment and long-term adverse outcome: a systematic review. Am J Obstet Gynecol 1999; 180:1024-9. [PMID: 10203673 DOI: 10.1016/s0002-9378(99)70676-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The medical literature was searched for publications between 1966 and September 1997 for data on the association of Apgar score, umbilical blood pH, or Sarnat grading of encephalopathy with long-term adverse outcome. Odds ratios for these associations were combined to calculate common odds ratios with 95% confidence intervals. Our search identified abstracts of 1312 studies and 81 articles with sufficient numeric data to formulate contingency tables. Forty-two of these qualified for inclusion in our meta-analysis. The strongest associations in the prediction of neonatal death were found by comparing umbilical artery pH <7 with pH >/=7 (common odds ratio 43; 95% confidence interval 15-124) and by comparing Sarnat grade III with grade II (common odds ratio 24; 95% confidence interval 13-45). In the prediction of cerebral palsy, the strongest associations were found for Sarnat grade III versus grade II (common odds ratio 20; 95% confidence interval 6-70) and for 20-minute Apgar score 0 to 3 versus 4 to 6 (common odds ratio 15; 95% confidence interval 5-50).
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Affiliation(s)
- J E van de Riet
- Department of Obstetrics and Gynaecology and the Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
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11
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Nangia S, Saili A, Dutta AK, Batra S, Ray GN. Free oxygen radicals--predictors of neonatal outcome following perinatal asphyxia. Indian J Pediatr 1998; 65:419-27. [PMID: 10771993 DOI: 10.1007/bf02761137] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study was undertaken to evaluate the role of free oxygen radicals in asphyxiated neonates. Thirty term neonates appropriate for gestational age and with severe birth asphyxia (Apgar score of 3 or less at 1 minute of life) formed the study subjects. The levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), creatine phosphokinase (CPK) and lipid peroxidase (LPO) in the CSF of these neonates were estimated between 12 and 48 hrs of life. Enzyme estimation was performed by standard methods and the results were analysed statistically using Multivariate Logistic Regression analysis and non parametric tests namely Kruskal Wallis test and Wilcoxon's rank sum test. Out of the thirty babies, 14 were observed to be neurologically normal, 9 had significant morbidity and 7 died. The SOD levels ranged from 12.4 to 140 units/ml, GPx from 128 to 1933 nmol/min/dl, CPK from 2 to 2098 IU/dl and LPO from 5.4 to 30.8 umol/hr/dl. The SOD and GPx levels had an inverse relationship whereas rise in LPO and CPK levels were directly proportional to the extent of neurological damage and ultimate clinical outcome. CPK levels higher than 140 IU/ml were lethal and associated with 100% mortality whereas all normal neonates had CPK below 37 IU/ml. The levels of antioxidant enzymes can reliably and significantly predict mortality and morbidity whereas level of an enzyme cannot confidently confer normalcy. Hence antioxidant enzyme levels with a cut off value can be a useful marker and serve as a prognostic indicator in times to come.
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Affiliation(s)
- S Nangia
- Department of Neonatology, Kalawati Saran Children's Hospital, New Delhi
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Talvik T, Haldre S, Sööt A, Hämarik M, Piirsoo A, Mikelsaar AV. Creatine kinase isoenzyme BB concentrations in cerebrospinal fluid in asphyxiated preterm neonates. Acta Paediatr 1995; 84:1183-7. [PMID: 8563233 DOI: 10.1111/j.1651-2227.1995.tb13521.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Creatine kinase isoenzyme BB was determined in cerebrospinal fluid (CSF) in 79 preterm neonates using an original enzyme-linked immunosorbent assay. The criterion for inclusion was an Apgar score of 7 or less at 5 min of life. Neurological examination was performed on day 2 and day 5 of life. CSF was obtained on the same days. Lumbar puncture was performed on 41 of these babies on day 2 and in 39 on day 5 of life (one baby underwent lumbar puncture twice). All babies had clinical features of hypoxic-ischemic encephalopathy (HIF) which was classified according to Sarnat and Sarnat. The control group consisted of 90 asphyxiated term babies and 30 adults without CNS pathology. The concentration of CK-BB in cerebrospinal fluid (mean +/- SD) was significantly higher (p < 0.0005) in preterm (168.0 +/- 2) than in term babies (29.0 +/- 3.1) and healthy adults (5.3 +/- 1.2). Our results demonstrate the possibility of using the classification system of Sarnat and Sarnat for assessment of the severity of brain damage not only in term, but also in preterm babies. Neonates with HIE stages II and III showed markedly higher CK-BB values than those with HIE I on day 2 (p < 0.025) and day 5 (p < 0.05) of life. CK-BB values were markedly higher in preterm babies with none of some primitive responses (head turning, Babkin's reflex, palmar grasp). The mean concentration of CK-BB was higher in neonates with retarded psychomotor development compared with those with normal development (p < 0.05) on day 3, and after 6 and 9 months. At 12 months of age no significant difference in median CK-BB concentration was detected between neonates with normal and developmental disturbances.
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Affiliation(s)
- T Talvik
- Department of Pediatrics, Children's Hospital, University of Tartu, Estonia
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13
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Fonseca E, Garcia-Alonso A, Zárate A, Ochoa R, Galván RE, Jimenez-Solis G. Elevation of activity of creatine phosphokinase (CK) and its isoenzymes in the newborn is associated with fetal asphyxia and risk at birth. Clin Biochem 1995; 28:91-5. [PMID: 7720233 DOI: 10.1016/0009-9120(94)00058-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the relationship of creatine phosphokinase and its isoenzymes with fetal asphyxia and risk at birth. METHODS Thirty-five pregnant women with high-risk pregnancy were studied. RESULTS In 21 patients, fetal distress was diagnosed by interpretation of the fetal heart rate tracing (FHR). The remaining 14 women, having normal fetal cardiotocography, were considered as the control group. Total CK and its isoenzymes activity was measured in cord sera and 24 h after birth in peripheral blood. Abnormal FHR patterns correlate well with elevated enzyme activities. Total CK and its isoenzymes (CK-MM, CK-MB, and CK-BB) exhibited higher values in asphyxiated infants as compared to normal neonates. Electrocardiographic ischemia occurred in seven newborns who had elevated CK-MB and CK-BB levels, both at birth and within 24 h postpartum. Chromatographic study showed in normal neonates that the predominant isoenzyme was CK-MM, whereas CK-BB activity was negligible. In the newborns with abnormal FHR, CK-MB and CK-BB were increased with predominance of CK-MB. CONCLUSIONS Antepartum fetal distress is associated with release of CK-BB, and particularly CK-MB; therefore, these biochemical markers may indicate either brain or myocardial damage.
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Affiliation(s)
- E Fonseca
- Endocrine Research Unit, Instituto Mexicano del Seguro Social, Mexico City
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Adhikari M, Moodley M, Desai PK. Cranial ultrasonography, CK-BB and neurological assessment as predictors of outcome in hypoxic ischaemic encephalopathy. ANNALS OF TROPICAL PAEDIATRICS 1993; 13:195-200. [PMID: 7687117 DOI: 10.1080/02724936.1993.11747645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A comparison of cranial ultrasonography, CK-BB and neurological assessment was undertaken in 30 (16 severely, 14 moderately) asphyxiated newborns. In the 16 severely asphyxiated newborns, cranial ultrasonography proved to be of value when changes of 'cerebral oedema' persisted for longer than 48 hrs. Although the mean creatine-kinase (CK-BB) activity at 12-33 hrs after birth was higher compared with that in controls of the same age, the numbers were too small in the different age categories for statistical analysis. The 81.25% specificity of ultrasound as compared with 76.47% of CK-BB suggests that the former investigation is a better indicator of cerebral injury. Phenobarbitone administered as an anticonvulsant in eight patients did not influence the CK-BB levels and the outcome in these babies. The persistence of neurological signs for more than 2 weeks predicted a poor outcome. Sixty-two per cent of the severely asphyxiated babies were light-for-dates, indicating that a chronic condition may have contributed to the poor overall prognosis in these neonates. From a combination of persisting abnormal appearances on cranial ultrasonography, elevated CK-BB activity and neurological impairment, death or significant neurological damage in nearly 90% of the severely asphyxiated babies could be predicted.
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Affiliation(s)
- M Adhikari
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Natal, Durban, South Africa
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15
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Millichap JG. Neonatal CSF Creatine Kinase and CP Risk. Pediatr Neurol Briefs 1992. [DOI: 10.15844/pedneurbriefs-6-1-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Serum creatine kinase BB (CK-BB) on the 1st day of life was measured by radioimmunoassay in 37 very low birth weight (VLBW) infants, 14 severely asphyxiated infants and 24 controls. The 31 survivors from the two high-risk groups were followed up for 12 months or more. VLBW non-survivors (n = 14) had significantly higher mean CK-BB levels than survivors (n = 23), (P less than 0.05). However, if only survivors were considered, CK-BB was a poor discriminator of outcome in either study group. First day serum CK-BB is not a useful predictor of neurodevelopmental outcome in surviving high-risk infants.
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Affiliation(s)
- R A Primhak
- Department of Paediatrics, Children's Hospital, Western Bank, Sheffield, UK
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Abstract
Serum creatine kinase BB-isoenzyme (CK-BB) activity was studied on the first day of life in 31 acutely asphyxiated infants, 70 infants born after high risk pregnancies (pre-eclampsia or intrauterine growth retardation, or both), and 47 very low birthweight infants. Neuro-developmental evaluation was carried out at 2.2-2.5 years. Eight infants died with, and eight without, hypoxic-ischaemic lesions of the brain, 14 had cerebral palsy, 16 had mild motor impairment, six had developmental delay without motor impairment, and 96 were normal at follow up. Infants who died with brain injury had significantly higher CK-BB activity than infants with normal outcomes (geometric mean 12 U/l); the mean difference was 82 U/l with a 95% confidence interval from 31 to 219 U/l. CK-BB in infants with cerebral palsy and mild motor impairment (geometric means 12 and 15 U/l, respectively) were similar to controls. CK-BB activity after birth is predictive of neonatal death but not of neurological damage in survivors.
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Affiliation(s)
- V J Ruth
- Children's Hospital, University of Helsinki, Finland
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18
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Amato M, Hüppi P, Gambon R, Schneider H. Biochemical timing of peri-intraventricular hemorrhage assessed by perinatal CPK-BB isoenzyme measurements. J Perinat Med 1989; 17:447-52. [PMID: 2699746 DOI: 10.1515/jpme.1989.17.6.447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Precise diagnosis of peri-intraventricular hemorrhage (PIVH) requires brain real-time ultrasound imaging procedure (US). However, maximal diagnostic efficiency of US lies between day 4 and 14 since fresh blood may initially appear sonolucent. Because of this supposed interval required for clot formation to become visible on US, serum CPK-BB estimations were performed in the first 60 hours of life to determine precise biochemical timing of PIVH. A group of 50 preterm infants less than 1500 g birth weight (1120 +/- 320 g) and 34 weeks gestation (30 +/- 3.7 weeks) was studied. Serial CPK-BB measurements were performed in serum immediately after birth (T0), then serially at time T1 (6-10 h), T2 (20-30 h), T3 (40-60 h). The incidence of PIVH diagnosed on the third day of life was 30%. Total CPK-BB values at T0 in infants who developed PIVH were significantly higher than those of patients without cerebral bleeding (70.8 +/- 30.5 vs 20.9 +/- 10.7 U/l) (p less than 0.05). The same statistically significant results were not observed analysing the CPK-BB values at T1, T2 and T3. These results suggest that most pathological conditions responsible for enzyme release occur in the pre- or perinatal period.
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Affiliation(s)
- M Amato
- Department of Obstetrics and Gynecology, University of Berne, Switzerland
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19
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Millichap JG. Serum CPK and Hypoxic-Ischemic Encephalopathy (HIE). Pediatr Neurol Briefs 1988. [DOI: 10.15844/pedneurbriefs-2-2-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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