Study on the clinical diagnostic value of determination of dynamic changes of plasma ADM contents in asphyxiated full-term neonates with hypoxic ischemic encephlopathy (HIE)

Objective: To assess the clinical diagnostic value of determination of dynamic changes of plasma ADM contents in asphyxiated full-term neonates for the development and severity of HIE with special emphasis on the immediate post-delivery umbilical blood specimen. Methods: Plasma adrenomedullin(ADM) and neuron-specific enolase(NSE) contents were determined with RIA dynamically(immediate post-delivery umbilical blood specimen, 24h, 3d, 7d after delivery) in 1) 32 asphyxiated full-term neonates without HIE 2) 78 asphyxiated full-term neonates developing HIE and 3) 30 normal neonates(umbilical blood specimen only). Results: 1)The plasma ADM contents in the umbilical blood specimen from the 32 neonates developing HIE were significantly higher than those in the 78 neonates asphyxiated but without HIE and normal neonates(168.15pg/ml vs 106.18pg/ml and 103.65pg/ml respectively). 2)Dynamically, the plasma ADM and NSE contents reached peak around 24h and dropped to about the same levels in normal neonates around 7d after delivery in neonates with mild and moderate degree HIE but remained significantly higher in neonates with severe HIE. Plasma ADM levels were positively correlated with the severity of HIE as well as the NSE levels (r=0.786, P<0.01). 3)By analyzing the ROC curve and area under the curve at different umbilical blood plasma contents of ADM, we found the cut-off value was set most appropriately at 117.5pg/ml, the diagnostic accuracy for HIE was 88.9% with a sensitivity of 91% and specificity of 83.3%. Conclusion: Determination of umbilical blood specimen plasma ADM contents(cut-off value 118pg/ml) was very helpful for early recognition of HIE in asphyxiated full-term neonates. (authors)