1 Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, 10461
Thank you for the opportunity to comment on Dr. Gordon Millichap's letter.
I agree with Dr. Millichap that perinatal cerebral trauma or cerebral hypoxia cannot be overlooked as a possible additional etiological factor in the elevation of serum CPK levels in some infants. However, the lack of correlation with 1-minute Apgar scores, and the frequency of elevated serum enzyme levels in newborns who do not exhibit clinical signs of neurological damage, make it unlikely that a central neurogenic mechanism is operative in the majority of cases.