The prognostic value of ischemia modified albumin in newborns with hypoxic ischemic encephalopathy

Aim: The early diagnosis and treatment of hypoxic ischemic encephalopathy (HIE) is important because of its high morbidity and mortality. Despite the use of various diagnostic and prognostic tests, these lack sufficient specificity and sensitivity. This study was intended to investigate the role of ischemia modified albumin (IMA), a hypoxia-specific marker, in the early diagnosis of HIE and determination of prognosis.Materials and Methods: The study was performed with 22 patients diagnosed with HIE (study group) and 22 healthy newborns (control group) with similar demographic characteristics at the Karadeniz Technical University Medical Faculty Farabi Hospital Neonatal Intensive Care Unit, Turkey. In addition to routine tests, IMA levels in the study group were investigated from cord blood and blood specimens in increasing quantities taken for routine tests at hours 6, 24, 48 and 72. In the control group, IMA levels were investigated in every neonate from cord blood and blood specimens in increasing quantities taken for other postnatal tests. The relation between cases? demographic characteristics and laboratory parameters and IMA levels was investigated.Results: Average gestational age in the study and control groups was 37.7±3.2 (32-44) weeks and 38.5±2.4 (35-42) weeks, respectively. Average birth weight was 2708±851 (990-3760) g and 3107±566 (2100-4100) g, again respectively (p<0.05). There was no statistically significant difference between the groups in terms of birth weight, type of delivery or gender (p>0.05). Two (nine percent) of the study group cases were evaluated as stage I HIE, 14 (63.7%) as stage II HIE and 6 (27.3%) as stage III HIE. Although initial study group IMA levels (65±0.1 ABSU) were higher compared to those in the control group (0.63±0.1 ABSU), the difference was not statistically significant (p>0.05). IMA levels measured at various times over the first 72 h followed a fluctuating course. No statistically significant correlation was determined between IMA levels and gestational age, type of delivery, gender, Apgar score, HIE stages, blood gas pH, aspartate aminotransferase, creatine kinase and lactate levels, or EEG and MRG findings (p>0.05).Conclusion: Our findings suggest that IMA cannot be employed as a useful marker in the early diagnosis and monitoring of HIE or in the determination of prognosis. However, we think that further studies involving wider case series are required in order to arrive at a definitive conclusion.