Are serum markers of liver and muscle injury useful in neonatal hypoxic-ischemic encephalopathy?

B.C. Hayes*, E. Doherty, A. Grehan, C. Madigan, C. McGarvey, S. Mulavany, M. Geary, T.G. Matthews, M.D. King | JNPM 2012;

Abstract:Aims: To determine the predictive value of lactate dehydrogenase (LDH), creatine phosphokinase (CPK), and transaminase concentrations in the first 96 hours after birth for grade of encephalopathy and neurodevelopmental outcome. Methods: Peak CPK, LDH and transaminase concentrations were collected in newborns with hypoxic ischaemic encephalopathy in the first 96 hours after birth. Receiver operating characteristic (ROC) curves were constructed and best cut off values were chosen. Children were assessed using a variety of standardised assessments. In children <42 months (n = 78) mean age at assessment was 26.2 months. In children ≥42 months (n = 68) mean age at assessment was 5 years 8 months. Results: The predictive value of LDH, AST, and ALT was of borderline significance (P = 0.046) when used to identify newborns with grade 3 encephalopathy. LDH (5000 U/L) was best for predicting abnormal outcome (sensitivity 50%, specificity 85%) followed by AST (100 U/L)(sensitivity 78%, specificity 59%). CPK was neither sensitive nor specific. LDH (5000 U/L) and AST (100 U/L) both showed a sensitivity of 36% and specificity 98% for the prediction of death or cerebral palsy. Conclusions: Wide interquartile ranges in LDH, CPK and transaminase concentrations in the first 96 hours after birth, limit their use as prognostic markers.

*Corresponding Author: 

Dr. Breda C. Hayes, 591 VFW Parkway, Boston, MA 02467, USA. Tel.: +1 617 610 9547; Emails:;;