LACTATE DEHYDROGENASE, ASPARTATE AMINOTRANSFERASE AND ALANINE AMINOTRANSFERASE LEVELS IN NEONATES WITH PERINATAL ASPHYXIA AT WESLEY GUILD HOSPITAL, ILESA, NIGERIA

Abstract

Perinatal asphyxia is a major cause of neonatal morbidity and mortality especially in
developing countries, including Nigeria. Babies with severe asphyxia may have hypoxic
ischaemic injuries to various organ systems of the body. The injuries often lead to the leakage
of intracellular enzymes such as lactate dehydrogenase (LDH), aspartate aminotransferase
(AST) and alanine aminotransferase (ALT) into the circulation. Assay of these enzymes may
have prognostic significance. The objectives of the present study were to determine the serum
levels of these enzymes in babies with perinatal asphyxia, the relationship of the serum levels
of these enzymes with severity of asphyxia using the Apgar score, the occurrence of hypoxic
ischaemic encephalopathy (HIE) and immediate outcome among the babies.
Consecutive term babies with perinatal asphyxia (PA) defined as Apgar score less
than 7 at one minute of life were recruited over an eight months period. Apparently healthy
age-and sex-matched term babies without PA were recruited as controls. Relevant history
was obtained from each mother and each baby was examined at birth. The pack cell volume,
random blood sugar and other routine investigations were done for each baby with PA. Cord
blood and 12-hour blood samples were obtained from both the cases and controls for LDH,
AST and ALT assays using Spectrophotometeric method. Babies with PA were monitored till
end of hospital admission.
Seventy babies with perinatal asphyxia and 70 controls were studied. There were 38
males and 32 females giving a male: female ratio of 1.2: 1 for each group. Thirty-six (51.4%)
of the cases had severe asphyxia (Apgar scores ≤ 3) while 34 (48.6%) had moderate asphyxia
(Apgar scores of 4-6) at one minute. The means of serum levels of LDH, AST and ALT were
significantly higher in the 12-hour samples than in the cord blood samples for both the
subjects and the controls (p < 0.001). The mean serum level of LDH, AST and ALT were
significantly higher in babies with perinatal asphyxia (PA) than the controls (p <0.001 for
each enzyme).
There was a positive correlation between the serum levels of the enzymes in both the
cord blood and 12-hour blood samples and severity of PA (r = 0.555, r = 0.647, r = 0.45 for
LDH, AST and ALT respectively in 12-hour blood samples). Fifteen (21.4%) of the cases
had hypoxic ischaemic encephalopathy (HIE). Means of serum levels of LDH, AST and ALT
were significantly higher in neonates with HIE than those without HIE (p < 0.001 for LDH,
AST and ALT in cord blood and 12-hour blood samples). Among babies with PA the means
of serum levels of LDH, AST and ALT were significantly higher in those that died than those
that survived (p < 0.001 for all the enzymes in 12-hour blood samples). Four (5.7%) of the
babies with PA died and one (1.4%) was discharged against medical advice. All the five
babies had HIE.
In conclusion, the present study showed that the serum levels of intracellular
enzymes, LDH, AST and ALT were significantly higher in babies with PA than apparently
healthy babies at the age of 12 hours and the enzyme levels also correlated well with the
severity of PA at this age. The enzyme levels were associated with severity of HIE and
mortality among the babies. Assaying the enzymes, especially at the age of 12 hours may
therefore be useful in the evaluation and prognostication in babies with PA. This may
facilitate early recognition of cases that may require neuroprotective interventions to improve
outcome in such babies.

LACTATE DEHYDROGENASE, ASPARTATE AMINOTRANSFERASE AND ALANINE AMINOTRANSFERASE LEVELS IN NEONATES WITH PERINATAL ASPHYXIA AT WESLEY GUILD HOSPITAL, ILESA, NIGERIA