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01-10-2017 | Original Article

Biomarkers of hepatic injury and function in neonatal hypoxic ischemic encephalopathy and with therapeutic hypothermia

Authors: Hemananda Muniraman, Danielle Gardner, Jane Skinner, Anna Paweletz, Anitha Vayalakkad, Ying Hui Chee, Clare Clifford, Sunil Sanka, Vidheya Venkatesh, Anna Curley, Suresh Victor, Mark A. Turner, Paul Clarke

Published in: European Journal of Pediatrics | Issue 10/2017

Abstract

Therapeutic hypothermia (TH) is now provided as standard care to infants with moderate-severe hypoxic ischemic encephalopathy (HIE). The role of TH in limiting neuronal injury is well recognized, but its effect on hepatic injury which occurs frequently in neonatal HIE is not known. Our objective was to characterize biomarkers of liver injury and function in the setting of neonatal HIE and to describe whether HIE severity and provision of TH influence these hepatic biomarkers. We performed a multicenter retrospective study and compared hepatic biomarkers obtained during the first postnatal week, according to the severity of HIE and whether treated with TH. Of a total of 361 infants with HIE, 223 (62%) received TH and 138 (38%) were managed at normal temperature. Most hepatic biomarkers and C-reactive protein (CRP) were significantly associated with the severity of HIE (p < 0.001). Infants treated with TH had lower peak alanine aminotransferase (ALT) concentrations (p = 0.025) and a delay in reaching peak CRP concentration (p < 0.001).

Conclusion: We observed a significant association between the clinical grade of HIE and biomarkers of liver metabolism and function. Therapeutic hypothermia was associated with delayed CRP responses and with lower ALT concentrations and so may have the potential to modulate hepatic injury.

What is Known:

• Ischemic hepatic injury occurs frequently as a part of multiorgan dysfunction in infants with hypoxic ischemic encephalopathy (HIE).

• The neuroprotective role of therapeutic hypothermia in management of infants with HIE is well recognized, but the potential hepato-protective effects of hypothermia are unclear.

What is New/What this study adds:

• Therapeutic hypothermia was associated with lower alanine aminotransferase and albumin concentrations and a delayed C-reactive protein (CRP) response and so may have the potential to modulate hepatic injury.

• An elevated CRP concentration during the first postnatal week may be regarded as an expected finding in moderate and severe HIE and, in the overwhelming majority of cases, occurs secondary to hepatic hypoxia-ischemia in the absence of blood culture-positive sepsis.

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Title: Biomarkers of hepatic injury and function in neonatal hypoxic ischemic encephalopathy and with therapeutic hypothermia
Authors: Hemananda Muniraman
Danielle Gardner
Jane Skinner
Anna Paweletz
Anitha Vayalakkad
Ying Hui Chee
Clare Clifford
Sunil Sanka
Vidheya Venkatesh
Anna Curley
Suresh Victor
Mark A. Turner
Paul Clarke
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 10/2017
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-017-2956-2

At a glance: The STEP trials

Springer Medicine

Biomarkers of hepatic injury and function in neonatal hypoxic ischemic encephalopathy and with therapeutic hypothermia

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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