A STUDY OF URINARY URIC ACID TO CREATININE RATIO IN PERINATAL ASPHYXIA

Abstract

BACKGROUND Perinatal asphyxia is one of the leading causes of neonatal mortality in developing countries. Birth asphyxia is an important cause of static development of neurological handicap both in term and preterm infants. This study was to evaluate the utility of urinary Uric acid to Creatinine ratio as non-invasive, easy, cheap and at the same time early biochemical marker of asphyxia. AIM AND OBJECTIVES OF THE STUDY To compare the ratio of urinary Uric acid to Creatinine among asphyxiated and non asphyxiated term neonates. MATERIALS AND METHODS This study includes 50 term neonates as controls from post natal wards and 50 term neonates ,clinically diagnosed as perinatal asphyxia with Apgar score is below 7 at one minute of life from neonatal intensive care unit. Spot urine samples were collected using sterile urine collection bags within 6-24 hours after birth and analyzed          immediately. Both the groups were analyzed for urine Uric acid by enzymatic method and Creatinine levels by Jaffe's method and the ratio between the two is derived. RESULTS It was found that urine Uric acid to Creatinine ratio was found to be significantly elevated in cases( mean value 2.480.75) than in controls (mean value 0.520.19 p0.001 significant). DISCUSSION During hypoxia, anaerobic glycolysis takes place, which produces only 2 ATPs as apposed to 38 ATPs produced from aerobic glycolysis. During prolonged hypoxia, cardiac  output falls, cerebral blood flow is compromised and a combined hypoxic-ischemic insult produces further failure of oxidative phosphorylation and ATP production sufficient to cause cellular damage leads to an accumulation of Adenosine diphosphate and Adenosine monophosphate, which is then catabolised to Adenosine, Inosine and Hypoxanthine. If there is uninterrupted tissue hypoxia and there is also reperfusion injury,  Hypoxanthine is oxidized to Xanthine and Uric acid in presence of Xanthine oxidase leading to an increased Uric acid, which come out in blood from tissues and excreted in urine.     CONCLUSION This ratio can be used as an early, cost               effective, simple, quick and non-invasive parameter, and a  supportive tool to the diagnosis of birth asphyxia.