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

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

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.

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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.

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