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Abstract
Purpose
Meconium aspiration syndrome (MAS), often progresses to respiratory failure and its' serious complication, persistent pulmonary hypertension of the newborn (PPHN) is a major cause of neonatal mortality. Early recognition of infants at the risk for respiratory failure in MAS patients is necessary for treatment. So we aimed to identify serum enzymes such as lactate dehydrogenase (LDH), aspartate transaminase (AST), and alanine transaminase (ALT) as serum biologic marker for early detection of respiratory failure in MAS patients.
Methods
Infants admitted within 24 hours after birth to Neonatal Intensive Care Unit of Dongguk University Ilsan Hospital and diagnosed with MAS from August 2005 to March 2014 were analyzed retrospectively. Serum enzymes were measured on admission.
Results
Of the total 60 patients diagnosed with MAS, 28 were in the positive pressure ventilation (PPV) group and 32 were in the non-PPV group. Six patients progressed to PPHN. Only serum LDH was significantly higher in the PPV group than the non-PPV group (median 1,123 vs. 831, P=0.01). Using the ROC curves, the cut-off value of 964 U/L for LDH offered the best predictive value for PPV requirement (sensitivity 61% and specificity 81%). Serum LDH was significantly higher in MAS with PPHN group than MAS without PPHN group (median 1,791 vs. 904, P=0.013). But serum AST, ALT were not predicting factor for the requirement of respiratory support and development of PPHN among MAS patients.
References
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Fig. 1.
Receiver operating characteristics (ROC) curve for the usefulness of serum enzymes to distinguish positive pressure ventilation group with non-positive pressure ventilation group. An area under ROC curve for LDH is 0.694 (95% Confidence interval 0.55–0.84, P=0.010). A cut off level of 964 U/L for LDH offered the best predictive value for PPV requirement (sensitivity 61% and specificity 81%). Abbreviations: AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase.
Table 1.
Clinical Characteristics of Positive Pressure Ventilation and Non-positive Pressure Ventilation Groups
Table 2.
Area under the Curve
| Variables | Area | P value | 95% Confidence Interval |
|---|---|---|---|
| LDH | 0.694 | 0.010 | 0.552–0.836 |
| AST | 0.636 | 0.072 | 0.491–0.780 |
| ALT | 0.608 | 0.151 | 0.462–0.755 |
Table 3.
Clinical Characteristics of Meconium Aspiration Syndrome Groups with Persistent Pulmonary Hypertension of Newborn or without Persistent Pulmonary Hypertension of Newborn
∗ Data were expressed as median±standard deviation and ranges in brackets or numbers of individuals with percentages in parentheses. Abbreviation: PPV, positive pressure ventilation; AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase; MAS, meconium aspiration syndrome PPHN, persistent pulmonary hypertension of newborn.
Table 4.
Clinical Characteristics of Meconium Aspiration Syndrome Groups with hypoxic ischemic encephalopathy or without hypoxic ischemic encephalopathy
∗ Data were expressed as median±standard deviation and ranges in brackets or numbers of individuals with percentages in parentheses. Abbreviations: PPV, positive pressure ventilation; AST, aspartate transaminase; ALT, alanine transaminase; LDH, lactate dehydrogenase; HIE, hypoxic ischemic encephalopathy; MAS, meconium aspiration syndrome.
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