Diagnostic Accuracy of Creatine Kinase-Muscle Brain Fraction and Lactate Dehydrogenase in Hypoxic Ischaemic Injury among Newborns: A Prospective Observational Study

Introduction: Perinatal asphyxia, contributes significantly to neonatal morbidity and mortality. In India, one third of deliveries are institutional and many asphyxiated newborns are brought late to health facility. These newborns don’t have proper perinatal records making it difficult to retrospectively diagnose perinatal asphyxia. There is an urgent need to identify new-born with asphyxia who are at high-risk for Hypoxic Ischaemic Encephalopathy (HIE) and multiorgan dysfunction. Aim: To study the Lactate Dehydrogenase (LDH) and Creatine Kinase-MB (CK-MB) levels in neonates suspected of hypoxic ischaemic injury for better diagnosis and treatment of perinatal asphyxia. Materials and Methods: The present prospective observational study was done from February 2023 to May 2024 in Special Newborn Care Unit (SNCU) of Government Medical College, Haldwani, Uttarakhand, India. Total 180 randomly selected neonates comprising of 90 asphyxiated and 90 non-asphyxiated newborns were included in the study. The blood samples for CK-MB and LDH were drawn at 8±2 hours and 72±2 hours of age, respectively and were immediately sent for analysis and sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Values (NPV) were calculated for each. Results: In present study, there were 100 males and 80 females with mean birth weight and age to be 2.9±0.5 kg and 38.3±1.4 weeks. CK-MB value of >92.6 U/L was found in 73 (81.1%) of asphyxiated new-born and LDH >580 U/L was found in 69 (76.6%) asphyxiated. LDH had a sensitivity of 83.13%, specificity of 97.78%, PPV of 97.40%, and NPV of 86.27%. CK-MB showed a sensitivity of 81.11%, specificity of 97.78%, PPV of 97.33%, and NPV of 83.81%. Conclusion: CK-MB and LDH were elevated in asphyxiated neonates compared to non-asphyxiated neonates and LDH was better at predicting hypoxic ischaemic injury as compared to CK-MB.