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. 2021 May 18;11(5):897.
doi: 10.3390/diagnostics11050897.

Identifying Early Diagnostic Biomarkers Associated with Neonatal Hypoxic-Ischemic Encephalopathy

Inn-Chi Lee  1   2 , Swee-Hee Wong  1 , Xing-An Wang  2   3 , Chin-Sheng Yu  4
Affiliations

Identifying Early Diagnostic Biomarkers Associated with Neonatal Hypoxic-Ischemic Encephalopathy

Inn-Chi Lee et al. Diagnostics (Basel). .

Abstract

Background: Identifying an effective method for the early diagnosis of neonatal hypoxic-ischemic encephalopathy (HIE) would be beneficial for effective therapies.

Methods: We studied blood biomarkers before 6 h after birth to correlate the degree of neonatal HIE. A total of 80 patients were divided into group 1 (mild HIE) and group 2 (moderate or severe HIE). Then, 42 patients from group 2 received hypothermia therapy and were further divided into group 3 (unremarkable or mild MRI results) and group 4 (severe MRI results).

Results: Between groups 1 and 2, lactate, creatinine, white blood cells, and lactate dehydrogenase (LDH) were significantly different. Between groups 3 and 4, lactate, prothrombin time, and albumin were significantly different. Sarnat staging was based on our observation that more than 45 mg/dL of lactate combined with more than 1000 U/L of LDH yielded the highest positive predictive value (PPV) (95.7%; odds ratio, 22.00), but a low negative predictive value (NPV) for moderate or severe HIE. Using more than 45 mg/dL of lactate yielded the highest NPV (71.4%) correlated with moderate or severe HIE.

Conclusions: Lactate combined with LDH before 6 h after birth yielded a high PPV. Using combined biomarkers to exclude mild HIE, include moderate or severe HIE, and initialize hypothermia therapy is feasible.

Keywords: MRI; biomarker; hypoxic-ischemic encephalopathy; lactate; newborn.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart of the study procedure. HIE indicates hypoxic-ischemic encephalopathy; MRI, magnetic resonance imaging.
Figure 2
Figure 2
Odds ratio of different biomarkers for determining Sernat staging of patients with neonatal HIE.
Figure 3
Figure 3
Feasible approach for treating patients with neonatal HIE.
See this image and copyright information in PMC

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