Post on 06-Nov-2021
1. Identify normal trends in laboratory values in neonates with HIE.
2. Define neonates who may need further evaluation for end-organ injury.
3. Associate blood gas findings with glucose values to determine etiology of hypoglycemia and hypocarbia.
Objectives:
0-6
7-12
13-1
8
19-2
4
25-4
8
49-7
272
+
0
1
2
3
4
Sarnat Scores over time
Time (hours)
responders
nonresponders
Score
0-6
7-12
13-1
8
19-2
4
25-4
8
49-7
272
+
0
1
2
3
4
Sarnat Scores over time
Time (hours)
responders
nonresponders
Score
Sarnat Scoring
Markers of Cardiac Ischemia
resp
onders
nonresp
onders
0
2000
4000
6000
8000
10000
12000
Creatinine Kinase total
responders
nonresponders
CK (U/L)
resp
onders
nonresp
onders
0
100
200
300
CK-MB
responders
nonresponders
CK-MB (U/L)
resp
onders
nonresp
onders
0.0
0.5
1.0
1.5
2.0
Troponin I
responders
nonresponders
Troponin (ng/mL) (p= 0.008)
0-6
7-12
13-1
8
19-2
4
25-4
8
49-7
272
+
6.6
6.8
7.0
7.2
7.4
pH over time
Time (hours)
responders
nonresponders
pH
Acid Base Balance
0-6
7-12
13-1
8
19-2
4
25-4
8
49-7
272
+
0
20
40
60
80
100
CO2 over time
Time (hours)
responders
nonresponders
CO2 (mmHg)
Acid Base Balance
0-6
7-12
13-1
8
19-2
4
25-4
8
49-7
272
+
-5
0
5
10
15
20
25
lactate over time
Time (hours)
responders
nonresponders
Mmol/L
0-6
7-12
13-1
8
19-2
4
25-4
8
49-7
272
+
-30
-20
-10
0
10
Base deficit over time
Time (hours)
responders
nonresponders
BD mmol/L
Renal function
0-6
7-12
19-2
4
25-4
8
49-7
272
+
0.0
0.5
1.0
1.5
CreatinineResponders vs Non Responders
Time (hours)
responders
nonresponders
Creatinine (mg/dL )
0.4
Renal Function
0-24
25-4
8
49-7
272
+
0
Fluid intakeResponders vs. Non Responders
Time (hours)
responders
nonresponders
40-60
60-80
80-100
>100
Fluid intake
(ml/kg/hr)
120
0-24
25-4
8
49-7
272
+
0
Urine outputResponders vs Non Responders
Time (hours)
responders
nonresponders
Urine output (ml/kg/hr)
<1 ml/kg/hr
1-4 ml/kg/hr
4-6 ml/kg/hr
>6 ml/kg/hr
(ml/kg/day)
Urine output (ml/kg/hr)
Alanine Aminotransferase (ALT)
0-6
7-12
19-2
4
25-4
8
49-7
272
+
0
50
100
150
200
250
Alanine aminotransferase (ALT)
responders vs non responders
Time (hours)
responders
nonresponders
ALT (U/L)
• Currently no reliable marker of response.
• Infants that don’t follow the trend require further evaluation.
• Electrolyte derangements worsen outcomes.
Summary: