Study to Determine Correlation of Elevated Serum Creatine Kinase-Muscle Brain Fraction (CK-MB) and Lactate Dehydrogenase (LDH) Levels with Asphyxia Neonatorum and Severity of Hypoxic Ischaemic Encephalopathy

Background: Asphyxia Neonatorum is a significant contributor to neonatal mortality and morbidity. Its burden in resource-poor countries prompts the development of investigative modalities that offers accuracy and affordability. Objective: To determine that serum CK-MB and LDH estimation could be markers of Asphyxia neonatorum, and the elevated levels directly correlate with the grade of severity of Hypoxic Ischemic Encephalopathy (HIE) as defined by Levine. Methods: In this single-center, non-interventional study, we included 100 asphyxiated neonates from level III NICU in the case group, and 100 apparently healthy neonates from the post-natal ward admitted over 18 months at RCSM Government Medical College and CPR Hospital, Kolhapur. 100 healthy neonates were the control group. Results: The median 8-hr serum CK-MB in the case group was 74 U/L and in the control group as 63.5 U/L with P<0.001. Whereas the median serum LDH level in the case group was 597 U/L and the control group was 383.5 U/L with P<0.001. Raised LDH (cut off 580 U/L) had 100% specificity, while CK-MB (cut off 92.6 U/L) had 100% specificity for asphyxia. Amongst the neonates with HIE (n=60), 56% had raised CK-MB (cut off 92.6) and 80% had raised LDH (cut off 580 U/L). 100% of neonates with HIE Grade III (n=9) had elevated CK-MB and LDH levels. Conclusion: The present study concluded that CK-MB and LDH as biochemical markers can be utilitarian in the diagnosis of perinatal asphyxia.