To Study the Role of Urinary Uric Acid to Creatinine Ratio as a Marker of Perinatal Asphyxia and Its Severity in Newborns
Sunita Arora, Arshpuneet Kaur, Mandeep S Khurana, Jaskiran K Sandhu
Asphyxia, HIE (Hypoxic–ischemic encephalopathy), UUA/Cr (Urinary uric acid to creatinine ratio)
Citation Information :
Arora S, Kaur A, Khurana MS, Sandhu JK. To Study the Role of Urinary Uric Acid to Creatinine Ratio as a Marker of Perinatal Asphyxia and Its Severity in Newborns. Curr Trends Diagn Treat 2021; 5 (2):85-88.
Objective: To compare urinary uric acid and creatinine ratio (UUA/Cr) among asphyxiated and nonasphyxiated neonates.
Background: Perinatal asphyxia is the leading cause of neonatal morbidity and mortality. The last few decades have seen many improvements in modern medicine but still, there is a lack of easily available biochemical markers to diagnose perinatal asphyxia more so in institutional deliveries.
Study design: Cross-sectional, comparative study.
Setting: NICU and postnatal wards of tertiary care center.
Participants: Forty asphyxiated and 40 healthy term newborns were enrolled in the study. Two milliliters of cord arterial blood was collected for a blood gas analysis in asphyxiated neonates only. Spot urine samples were collected within the first 24 hours of life in both asphyxiated and nonasphyxiated groups and analyzed for UUA/Cr ratio.
Results: The mean UUA/Cr ratio was found to be higher in asphyxiated (2.41 ± 0.58) than in nonasphyxiated neonates (1.58 ± 0.17) (p <0.001). There was a positive correlation between the UUA/Cr ratio and the severity of hypoxic–ischemic encephalopathy among asphyxiated neonates (p <0.001). A negative correlation was found of UUA/Cr ratio with Apgar score and umbilical cord blood pH. The cutoff value of the UUA/Cr ratio of 1.36 has 97.5% sensitivity, 100% specificity, 100% positive predictive value, 97.5% negative predictive value, and 98.7% accuracy.
Conclusion: This ratio can be used as a reliable diagnostic marker to detect perinatal asphyxia in neonates where adequate birth history is not available.
Snyder EY, Cloherty JP. Perinatal asphyxia and hypoxic ischemic encephalopathy. In: Cloherty JP, Stark Ann R, Eichenwald EC, et al., editors. Manual of neonatal care. 7th ed. Wolters Kluwer; p. 711.
WHO: perinatal mortality–a listing of available information. FRH/MSM.96.7. Geneva: WHO; 1996.
Krishnana E, Ponnusamy V, Sekar SP. Study of urinary uric acid and creatinine ratio as a marker of neonatal asphyxia for babies born in tertiary care hospital. Int J Res Med Sci 2017;5(12):5418–5423. DOI: 10.18203/2320-6012.ijrms20175466.
Choudhary L, Palsanis S, Berwal PK, et al. Study of urinary uric acid and creatinine as a marker of perinatal asphyxia and its correlation with different stages of HIE. J Preg Child Health 2017;4:336. DOI: 10.4172/2376-127X.1000336.
Yaswanth K, Babu MS, Srinivas K. Study of urinary uric acid to creatinine ratio in assessing the severity of birth asphyxia. IOSR-JDMS 2017;16(10):69.
Agarwal R, Jain A, Deorari AK, et al. Post resuscitation management of asphyxiated neonates. Ind J Pediatr 2008;75(2):175–180. DOI: 10.1007/s12098-008-0026-5.
Rieselbach RE, Steele TH. Influence of the kidney upon urate homeostasis in health and disease. Am J Med 1974;56(5):665–669. DOI: 10.1016/0002-9343(74)90633-0.
Pietz J, Guttenberg N, Gluck L. Hypoxantine: a marker for perinatal asphyxia. Obstet Gynaecol 1988;72(5):762–766. PMID: 3140152.
Dennis J, Johnson A, Mutch L. Acid-base status at birth and neurodevelopmental outcome at four and one-half years. Am J Obstet Gynecol 1989;161(1):213–220. DOI: 10.1016/0002-9378(89)90269-x.
Mahmoud R, El Abd D. Urinary uric acid/creatinine ratio in term infants with perinatal asphyxia. Small 2016;32:80.
Kataria D, Joshi K, Singh J. Spot urine uric acid level as early marker of kidney injury in birth-asphyxiated newborns. Int J Sci Study 2019;6(11):24–28. DOI: 10.17354/ijss/2018/6.
Palit S, Wilar R, Runtunuwu A, et al. Blood pH and urinary uric acid-creatinine ratio in newborns with asphyxia. J Paediatr Indonesiana 2015;55(6):352–356. DOI: 10.14238/pi55.6.2015.
Patel KP, Makadia MG, Patel VI, et al. Urinary uric acid/creatinine ratio–a marker for perinatal asphyxia. J Clinic Diag Res 2017; 11(1):SC08. DOI: 10.7860/JCDR/2017/22697.9267.
Nariman S, Mosayebi Z, Sagheb S, et al. Urinary uric acid and creatinine ratio as a marker of mortalityand unfavourable outcome in NICU admitted neonates. Iran J Pediatr 2016;26(4):e5739. DOI: 10.5812/ijp.5739.
Rajmoham T, Sarayna R. Study of urinary uric acid and creatinine as a marker for neonatal asphyxia. IP Int J Med Pediatr Oncol 2019;5(2): 66–68. DOI: 10.18231/j.ijmpo.2019.015.
Akisü M, Kültürsay N. Value of the urinary uric acid to creatinine ratio in term infants with perinatal asphyxia. Pediatr Int 1998;40(1):78–81. DOI: 10.1111/j.1442-200x.1998.tb01408.x.
Nagdy N, Komen W, Ko HK. Early biochemical indicators of hypoxic ischemic encephalopathy after birth asphyxia. Pediatr Res 2001;49(4):502–506. DOI: 10.1203/00006450-200104000-00011.