Journal List > Korean J Perinatol > v.25(4) > 1013728

TOOLS
An, Kim, Yang, Jeong, and Kim: Serum Enzymes in Predicting Transient Tachypnea of Newborn and Respiratory Distress Syndrome
Original Article

Korean J Perinatol 2014;25(4):284-291.

Published online: 21 December 2014

DOI: https://doi.org/10.14734/kjp.2014.25.4.284

Serum Enzymes in Predicting Transient Tachypnea of Newborn and Respiratory Distress Syndrome

Young Seok An, M.D., In Uk Kim, M.D., Mu Yeol Yang, M.D., Hye Ryeong Jeong, M.D., Hee Sup Kim, M.D.

Department of Pediatrics, Dongguk University Ilsan Hospital, Ilsan, Korea

Received 27 September 201415 October 2014       Accepted 17 October 2014

Copyright © 2014 Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Perinatal asphyxia is a major factor correlated with diseases that cause respiratory distress in a neonate. So we aimed to investigate the relationship between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) with plasma biological markers of perinatal asphyxia in full-term neonates.

Methods

Full-term neonates with transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) who were admitted within 24 hours after birth were enrolled in a study group. And control group are infants with premature rupture of amniotic membrane without significant findings. Serum lactate dehydrogenase (LDH), aspartate transaminase (AST), alanine transaminase (ALT), creatine kinase (CK) and myoglobin were measured at admission.

Results

Of the total 80 infants, 54 were of the study group and 26 were of the control group. The numbers of RDS and TTN groups were 27 and 27, and the numbers of RDS with hypoxic-ischemic encephalopathy (HIE) and RDS without HIE were 6 and 21 retrospectively. Serum AST, ALT, LDH and CK were significantly higher in the study group than the control group (P<0.05). When RDS group and TTN group were compared AST and LDH were significantly higher in RDS group than TTN group (P<0.05). Serum AST, ALT and LDH were significantly higher in RDS with HIE group than RDS without HIE group (P<0.05). A prediction of RDS by LDH analysis showed good correlation by receiver operating characteristic curve (P<0.05). A cut off level of 720 IU/L for LDH was the best predictor of RDS (sensitivity 63% and specificity 86%).

Conclusion

LDH is an excellent predictor to differentiate RDS from TTN soon after birth in full-term neonates with respiratory distress.

Keywords: Respiratory distress syndrome, Transient tachypnea of the newborn, Lactate dehydrogenase, spartate transaminase, Neonate

REFERENCES

1.Lee JM., Kim DK., Lee SJ. Probable prognostic factors among the revealing clinical manifestations at admission in neonates with tachypnea. J Korean Soc Neonatol. 2006. 13:32–9.
2.Ozkiraz S., Gokmen Z., Boke SB., Kilicdag H., Ozel D., Sert A. Lactate and lactate dehydrogenase in predicting the severity of transient tachypnea of the newborn. J Matern Fetal Neonatal Med. 2013. 26:1245–8.
crossref
3.Chang JY., Kim CR., Kim EA., Kim KS. Predictable risk factors and clinical courses for prolonged transient tachypnea of the newborn. Korean J Pediatr. 2010. 53:349–57.
crossref
4.Jackson JC. Respiratory distress syndrome. Gleason CA, Devaskar SU, editors. editors.Avery's disease of the newborn. 9th ed.Philadelphia: Elsevier Saunders Co;2012. p. 633–46.
5.Sykes GS., Molloy PM., Johnson P., Gu W., Ashworth F., Stirrat GM, et al. Do Apgar scores indicate asphyxia? Lancet. 1982. 1:494–6.
crossref
6.Lackmann GM. Influence of neonatal idiopathic respiratory distress syndrome on serum enzyme activities in premature healthy and asphyxiated newborns. Am J Perinatol. 1996. 13:329–34.
crossref
7.Kim DH., Shim SY., Kim JR., Shin SH., Kim ES., Joung KE, et al. Recent outcome of extremely low birth weight infants: The use of CRIB (clinical risk index for babies) II score for analyzing the survival rate. Korean J Pediatr. 2006. 49:952–8.
8.Levene MI., Sands C., Grindulis H., Moore JR. Comparison of two methods of predicting outcome in perinatal asphyxia. Lancet. 1986. 1:67–9.
crossref
9.Barberi I., Calabro MP., Cordaro S., Gitto E., Sottile A., Pru-dente D, et al. Myocardial ischaemia in neonates with perinatal asphyxia. Electrocardiographic, echocardiographic and enzymatic correlations. Eur J Pediatr. 1999. 158:742–7.
10.Karlsson M., Blennow M., Nemeth A., Winbladh B. Dynamics of hepatic enzyme activity following birth asphyxia. Acta Paediatr. 2006. 95:1405–11.
crossref
11.Karlsson M., Dung KT., Thi TL., Borgstrom E., Jonstam K., Kasstrom L, et al. Lactate dehydrogenase as an indicator of severe illness in neonatal intensive care patients: a longitudinal cohort study. Acta Paediatr. 2012. 101:1225–31.
crossref
12.Karlsson M., Wiberg-Itzel E., Chakkarapani E., Blennow M., Winbladh B., Thoresen M. Lactate dehydrogenase predicts hypoxic ischaemic encephalopathy in newborn infants: a preliminary study. Acta Paediatr. 2010. 99:1139–44.
crossref
13.Lackmann GM., Tollner U., Mader R. Serum enzyme activities in full-term asphyxiated and healthy newborns: enzyme kinetics during the first 144 hours of life. Enzyme Protein. 1993. 47:160–72.
crossref
14.Son MK., Kang ES., Jung SH., Choeh K. Significance of creatine kinase isoenzymes for neurologic outcome in perinatal asphyxia. Korean J Pediatr Soc. 1996. 39:924–33.
15.Kasik JW., Leuschen MP., Bolam DL., Nelson RM. Rhabdomyolysis and myoglobinemia in neonates. Pediatrics. 1985. 76:255–8.
crossref
16.Kojima T., Kobayashi T., Matsuzaki S., Iwase S., Kobayashi Y. Effects of perinatal asphyxia and myoglobinuria on development of acute, neonatal renal failure. Archives Dis Child. 1985. 60:908–12.
crossref
17.Lackmann GM., Tollner U. The predictive value of elevation in specific serum enzymes for subsequent development of hypoxic-ischemic encephalopathy or intraventricular hemorrhage in full-term and premature asphyxiated newborns. Neuropediatrics. 1995. 26:192–8.
crossref
18.Burtis CA., Ashwood ER., Bruns DE. editors.Tietz tesxtbook of clinical chemistry and molecular diagnostics. 4th ed.St. Louis: Elsevier Saunders Co;2006. p. 657–60.
19.Shah P., Riphagen S., Beyene J., Perlman M. Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004. 89:152–5.
crossref
20.Henrion J., Schapira M., Luwaert R., Colin L., Delannoy A., Heller FR. Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases. Medicine (Baltimore). 2003. 82:392–406.
21.Gibson PR., Dudley FJ. Ischemic hepatitis: clinical features, diagnosis and prognosis. Aust N Z J Med. 1984. 14:822–5.
crossref
22.Nelson DL., Cox MM. Lehninger principles of biochemistry. 3rd ed.Newyork: Worth Publishers;2000. p. 206.
23.Reddy S., Dutta S., Narang A. Evaluation of lactate dehydrogenase, creatine kinase and hepatic enzymes for the retrospective diagnosis of perinatal asphyxia among sick neonates. Indian pediatr. 2008. 45:144–7.
24.Warburton D., Singer DB., Oh W. Effects of acidosis on the activity of creatine phosphokinase and its isoenzymes in the serum of newborn infants. Pediatrics. 1981. 68:195–7.

Fig. 1.
Receiver operating characteristics (ROC) curve for lactate dehydrogenase (LDH) to discriminate respiratory distress syndrome among neonatal respiratory disease. An area under ROC curve for LDH is 0.765 (95% Confidence interval 0.63-0.89, P=0.001). A cut off level of 720 IU/L for LDH was the best predictor of RDS (sensitivity 63% and specificity 86%).
kjp-25-284-f1.tif
Table 1.
Clinical characteristics of patients with respiratory distress syndrome or transient tachypnea of the newborn and control group
Patients with RDS or TTN (n=54) Control (n=26) P-value
Gestational age (weeks) 38.9±1.3 38.3±1.3 0.089
Birth weight (g) 3186.0±400.5 2849.2±599.3 0.013
Cesarean section 21 (62%) 10 (38%) 0.046
Male 38 (70%) 13 (50%) 0.076
Apgar score (1 minute) 7.3±2.0 8.1±1.2 0.041
Apgar score (5 minute) 8.5±1.7 9.1±0.6 0.059
Duration of O2 1.2±2.3 0 0.000
Duration of total PPV 2.7±5.4 0 0.000
AST 98.8±107.0 32.1±23.9 0.000
ALT 23.3±37.7 9.6±4.2 0.011
LDH 979.3±1,114.5 325.4±97.3 0.000
Creatine kinase 1,731.4±2,929.8 295.3±295.4 0.001
Myoglobin 519.0±1683.0 97.4±94.7 0.235

Abbreviations: RDS, respiratory distress syndrome; TTN, transient tachypnea of the newborn; PPV, positive pressure ventilation; AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase. Values are expressed as mean±standard deviation.

Table 2.
Clinical characteristics of respiratory distress syndrome group and transient tachypnea of the newborn group
RDS (n=27) TTN (n=27) P-value
Gestational age (weeks) 38.8±1.5 38.9±1.1 0.717
Birth weight (g) 3192.6±44.0 3179.4±360.1 0.905
Cesarean section 15 (56%) 18 (69%) 0.305
Male 16 (59%) 22 (81%) 0.074
Apgar score (1 minute) 6.8±2.6 7.7±1.2 0.217
Apgar score (5 minute) 8.0±2.2 9.0±1.0 0.110
Duration of O2 5.9±6.5 2.0±4.3 0.013
Duration of total PPV 4.8±6.7 0.7±2.3 0.005
AST 130.2±140.8 67.5±38.3 0.033
ALT 33.1±51.7 13.6±5.3 0.062
LDH 1,368.2±1,463.2 590.5±277.9 0.011
Creatine kinase 2,236.4±4,006.1 1,226.5±958.7 0.213
Myoglobin 796.9±2384.6 251.4±214.4 0.242

Abbreviations: RDS, respiratory distress syndrome; TTN, transient tachypnea of the newborn; PPV, positive pressure ventilation; AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase. Values are expressed as mean±standard deviation.

Table 3.
Clinical characteristics of respiratory distress syndrome with hypoxic-ischemic encephalopathy and respiratory distress without hypoxic-ischemic encephalopathy
RDS with HIE (n=6) RDS without HIE (n=21) P-value
Gestational age (weeks) 38.7±1.8 38.8±1.4 0.787
Birth weight (g) 3110.6±481.1 3216.0±442.6 0.618
Cesarean section 3 (50%) 12 (57%) 0.756
Male 3 (50%) 13 (62%) 0.601
Apgar score (1 minute) 3.2±1.6 8.3±0.9 0.000
Apgar score (5 minute) 5.0±1.5 9.2±0.8 0.000
Duration of O2 10.5±12.7 4.6±2.8 0.312
2 Duration of total PPV 9.5±13.3 3.4±2.4 0.322
AST 305.6±213.9 80.1±49.8 0.049
ALT 104.6±76.9 12.7±4.8 0.033
LDH 3356.1±2114.4 800.2±376.0 0.031
Creatine kinase 6837.0±6974.7 921.9±733.4 0.092
Myoglobin 3166.6±5154.6 232.7±236.1 0.272

Abbreviations: RDS, respiratory distress syndrome; HIE, hypoxic ischemic encephalopathy; PPV, positive pressure ventilation; AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase. Values are expressed as mean±standard deviation.

TOOLS
Similar articles