ABSTRACT
The study included 50 full term newborns with a 5 minute Apgar score =16 suffering from hypoxic- ischemic-encephalopathy [HIE] as well as 10 apparently normal neonates as controls. Cases showed significantly higher mean levels of creatine kinase brain isoenzyme [CK-BB], lipid peroxide [L. per] and nitric oxide [NO] than controls. Similar effects were shown in abnormal mode of delivery [ventose and LSCS] and cases with moderate and severe HIE [group II]. Similar findings were also present when EEG or sonographic abnormalities were encountered. This was also true in the presence of cerebral hemorrhage as detected by cranial sonography. Fatality rate was 20%. Cases with fatal outcome showed significantly higher prevalence of ventose and LSCS delivery, apnea, HIE group II, frequent convulsions abnormal EEG and sonographic findings, together with significantly higher serum and CSF CK-BB enzyme levels, L.per and NO levels and significantly lower levels of SOD and T.th than the rest of cases. Significant positive correlations were found between each of serum, CSF CK-BB and L.per [P<0.001] and between each of serum, CSF CK-BB and NO [P<0.007]. Significant negative correlations were observed between each of serum, CSF CK-BB and SOD [P<0.001], and serum, CSF CK-BB and T.th [P<0.001]
Conclusion: the consequences of perinatal asphyxia and HIE are tremendous. Both metabolic and biochemical changes are recorded. Enzymes as well as increases in injurious oxygen free radicals [L.per and NO] with decreases in the cell defence antioxidants [SOD and T.th] occur. Factors that lead to HIE are in the major part preventable [by good antenatal and perinatal care with fetal monitoring]. The present study has highlighted areas of intervention and treatment of HIE. Knowledge of cellular and biochemical events that occur in HIE may lead to recognition of certain steps that may be amenable to pharmacologic intervention to limit or even prevent neuronal cell damage due to HIE. The bleak outcome of HIE may be improved. Apgar score commonly used to judge asphyxia was not found to be a reliable indicator of HIE severity and/or outcome