PROGNOSTIC VALUE OF ANGIOGENIN IEVELS IN CORRELATION WITH THE CEREBRAL SONOGRAPHIC FINDINGS IN NEONATAL HYPOXIA

Abstract

SUMMARY N eonatal encephalopathy and its subset of hypoxic-ischemic encephalopathy (HIE) are terms that describe abnormal neurobehavioral condition that consists of abnormal consciousness, tone, reflexes, feeding, respiration & seizures. Despite great improvements in perinatal practice made during the past decades, the mortality and incidence of cerebral palsy caused by hypoxic-ischemic encephalopathy (HIE) have remained unchanged, partly because of the absence of early diagnosis and identification methods. Pulsed Doppler ultrasound has been used extensively in neonates to evaluate their cerebral hemodynamic changes, and many studies had also demonstrated that the cerebral hemodynamic disturbance involved in the pathophysiologic mechanisms of neonatal HIE which can be used as an early diagnostic and prognostic tool for HIE development. Angiogenin (ANG) is a potent stimulator of new blood vessels through the process of angiogenesis. ANG hydrolyzes cellular RNA, resulting in modulated levels of protein synthesis and interacts with DNA causing a promoter-like increase in the expression of rRNA Angiogenin is associated with cancer and neurological disease through angiogenesis and through activating gene expression that suppresses apoptosis. In this study we measured serum Angiogenin in preterm neonates (1st sample to any preterm, 2nd sample after occurrence of neonatal hypoxia) with correlation to cerebral ultrasound Doppler done at the bedside measuring (RI) changes which indicated changes in cerebral blood flow velocity suggesting the diagnosis of hypoxia. The current study was an observational study conducted in the period from August 2014 to January 2015 in neonatal intensive care unit, Ain Shams University. The studied groups involved 40preterm neonates <37 weeks of gestation subjected to any state of neonatal hypoxia classified according to Sarnat staging into 20 cases of moderate and 20 severe HIE. The studied groups consisted 45% females and 55% males with mean gestational age 32.9 weeks 2.36 SD. Their mean birth weight was 1.89 ± 0.57 SD, 57.5% were delivered vaginally and 42.5% were delivered by CS. Our study showed no statistical significant differences between cases of moderate and severe HIE as regards gestational age, birth weight and the distribution of males and females. Our study showed that preterm with severe HIE have statistically significantly higher percentage of occurrence of antepartum hemorrhage than the preterm with moderate HIE (x2=4.444) (p=0.035). Our study showed no statistical significant differences between cases of moderate and severe HIE as regards neonatal risk factors for hypoxia. Our study showed no statistical significant difference between cases of moderate and severe HIE as regards TLC, HGB, HCT and PLT. Our study showed positive correlation and significant between Apgar, Maternal age and resistive index, the rest have insignificant. Our study showed no statistical significant differences between cases of moderate and severe HIE as regards RI values with (Mean ± SD=0.63 ± 0.12) for moderate cases and (0.61 ± 0.12) for sever cases. In our study a Receiver operating characteristics (ROC) curve was used to define the best cut off value of resistive index which was <0.52, with sensitivity of 30% specificity of 95% positive predictive value of 85.7%, negative predictive value of 57.6% with diagnostic accuracy of 60.1%.