STUDY ON PERINATAL ASPHYXIA ON CHILDRENADMITTED IN OUR PEDIATRIC INTENSIVE CARE UNIT

Muralidhar Reddy.K; Anil Kumar.P; Chandra Mohan.P; Sreenivasachowdary.J

Volume : VII, Issue : XII, December - 2017

STUDY ON PERINATAL ASPHYXIA ON CHILDRENADMITTED IN OUR PEDIATRIC INTENSIVE CARE UNIT

Muralidhar Reddy. K, Anil Kumar. P, Chandra Mohan. P, Sreenivasachowdary. J

Abstract :

Objectives: Perinatal asphyxia is one of the most common causes of neonatal mortality and morbidity in India. To know the outcome of asphyxia sophisticated devices like EEG, CT and MRI, are needed which are unlikely to be available in many parts of our country. The illness can be explained based on the evaluation of biochemical markers and many studies have been done so far reporting varied results. This study is to ascertain the extent of biochemical abnormalities in correlation to clinical presentation and the significance of the biochemical markers in explaining the outcome of the asphyxia.

Methods: The study includes 100 asphyxiated newborns, consecutively admitted in Neonatal Intensive Care Unit, Narayana Medical College Hospital, Nellore, during the period of November 2016to November 2017.Out of 100 asphyxiated newborns, 62 were delivered at Narayana Medical College Hospital, Nellore and 38 were delivered outside the institute and ought within 6 hours of life to the Narayana Medical College Hospital, Nellore. Perinatal asphyxia has been considered based on the umbilical arterial pH, APGAR and need for resuscitative efforts at the time of birth. The babies were categorized into two groups with the prescribed criteria as Group A (n=48), and Group B (n=52)groups, respectively. Data was analyzed using Z test and Chi square test. ROC curves have been laid in explaining the best biochemical marker.

Results: The mean gestational age among Group A and Group B are 37.6weeks +3.8and 37.4weeks +7.16 respectively. The biochemical markers taken into thestudy are Serum electrolytes sodium, potassium, calcium which were performed on day 1of life; Liver enzymes, lactate dehydrogenase (LDH), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and Renal function tests — Blood urea and Serum Creatinine which were done on day 3 of life. The clinical presentation was correlated clinically with the biochemical abnormalities. The study has shown that the duration of hospital stay is directly proportional to the severity of the abnormalbiochemical markers. Group A babies have got more antenatal, and natal risk factors, in a statistically significant manner, when compared with Group B. All the newborns of Group A landed in HTE II / III, whereas only 20 (38.5%)newborns of group B landed in HIE II/III. Blood urea, serum creatinine and Serum LDH values were showing significantstatisticaldifferencesbetween two groups. Out of these biochemical markers Serum LDH appears to be more sensitive and specific in explaining the severity of asphyxia.

Conclusion: Biochemical markers help a lot in explaining the severity and outcome of the asphyxiated illness, especially where sophisticated devices are not available. Among the markers, Serum Lactate dehydrogenase is the most accurate in explaining the outcome.