A study of urinary uric acid to creatinine ratio in assessing the severity of birth asphyxia

Background:perinatal asphyxia contributes to almost 20% of neonatal deaths in India OBJECTIVE.To determine prospectively urinary uric acid to creatinine ratio in perinatal asphyxia and showing increased uric acid excretion in early spot urine for identification of perinatal asphyxia. Material &Methods:. The study was conducted in babies admitted to neonatal intensive care unit at niloufer hospital attached to osmania medical college hyderabad on 200 babies delivered between 1/6/2015 to 31/05/2016 Out of which 100 babies are asphyxiated , rest 100 are healthy infants. Urinary uric acid was estimated by auto analyzer by spectrophotometric uricasemethod.urinary creatinine was estimated in same above instrument by using modified kinetic Jaffe’s method .Results: Among the 100 neonates in case group, 40 (40%) had increased tone neurologically, 42(42%) had mild and marked hypotonia and 18(18%) were flaccid with severe hypotonia. All the 100 (100%) neonates in control group had normal neurological examination. Abnormal neurological examination is significantly more in cases when compared to Controls with P< 0.001Among the 100 neonates in case group, 40( 40%) had no seizures. 60(60%) had seizures as an abnormal neurological examination finding . Abnormal neurological examination is significantly more(60.%) in cases when compared to Controls with P<0.001.Among the 100 neonates in the case group, 40(40%) had mild HIE, 42(42%) had moderate HIE and 18(18%) had severe HIE during the course in NICU. Cases and control were randomly selected, 100 cases (Neonatal Asphyxia) and control of 100 cases (normal newborns), were undertaken in assessing the Urinary Acid / Creatinine ratio as a marker in neonatal Asphyxia, the correlation of of urinary uric acid and creatinine ratio(UUA/Cr ) with HIE status among the cases and it was found to be statistically significant with a p value of < 0.001 Conclusions: The cut-off UAA/Cr value of >1.4 has 94% sensitivity with a specificity of 96% and has a positive predictive value of 95.52% with a negative predictive value of 94.12%.With an accuracy of 95%

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