Published online January 2, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S136 (doi:10.1542/peds.2007-2022DDDDD)
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NEONATOLOGY


IONIZED SERUM CALCIUM, NOT SERUM TOTAL MAGNESIUM, PREDICTS OUTCOME IN NEONATAL HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Hoda Atwaa, Hesham Elshala, Amal S. Ahmedb and Mohamed Matawiec

a Departments of Pediatrics
b Clinical Pathology
c Gynecology and Obstetrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

ABSTRACT

INTRODUCTION: Perinatal hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal mortality. Previous studies have attempted to find a sensitive parameter that will accurately predict outcome in infants with perinatal asphyxia.

OBJECTIVE: With this study we aimed to determine whether the serum total magnesium (Mg), ionized Ca (iCa), and sodium (Na) levels could predict the outcome of HIE.

METHODS: This was a hospital-based prospective study of admission to a newborn NICU. A total of 60 term neonates with HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat. Twenty healthy term newborns were chosen as controls. Total Mg, iCa, and Na levels were measured in umbilical cord blood and after 48 hours in blood. Neurologic examination was performed at 6 and 12 months. Outcome was scored as normal, disability, or death.

RESULTS: In normal infants there was a significant increase in serum total Mg and decrease in iCa concentrations by the second day of life as compared with that from umbilical cord blood. Infants with mild HIE had significantly higher umbilical cord blood total Mg levels compared with that of infants with moderate (P = .001) and severe (P = .02) HIE. On the second day of life, infants with severe HIE had significantly higher serum total Mg levels (P < .001) and lower iCa levels (P < .001) compared with those in the mild-HIE group. No significant differences between infants with severe and moderate HIE were observed regarding cord blood and 48-hour total Mg, iCa, and Na levels. The serum cord-blood and 48-hour iCa concentrations were significantly lower in the group of infants with HIE who had a poor outcome (odds ratios: 0.82 ± 0.10 and 0.70 ± 0.09) as compared with those with a good outcome (0.91 ± 0.08 and 0.86 ± 0.08) (P < .001 and P < .000, respectively).

CONCLUSIONS: Cord-blood and 48-hour levels of iCa and 48-hour Na could predict poor outcome in infants with HIE.

Submitted by Hoda Atwa