All issues > Volume 39(7); 1996

Original Article

J Korean Pediatr Soc. 1996;39(7):924-933. Published online July 15, 1996.

Significance of Creatine Kinase Isoenzymes for Neurologic Outcome in Perinatal Asphyxia

Mi Kyung MK Son¹, Eun Sik ES Kang¹, Sun Hi SH Jung¹, Kyuchul Kc Choeh¹

¹Department of Pediatrics, Eulji General Hospital, Taejon, Korea

Abstract

Purpose
: To investigate the usefulness of the serum Creatine kinase(CK), especially brain typical creatine kinase(CK-BB) as an indicator of brain damage extent, mortality and long term nurologic sequelae, the study was done.
Methods
: CK and CK isoenzyme activites were measured at 6-10 hours after birth in 160 asphyxiated newborn infants who admitted in Eulji General Hospital from August 1990 to July 1994. Infants were followed up for 1 years after birth to evaluate survival and neurologic outcome.
Results
: 1) There was low correlation between CK-BB and 5 minute Apgar score(r=0.245, p=0.0026). 2) There was intermediate correlation between CK-BB and Lactic dehydrogenase (LDH) (r=0.470, p<0.0001). 3) Infants who died within 24 hours after birth had significantly higher CK-BB activity(144.9¡¾ 98.5U/L) than survivors(82.2¡¾159U/L), (p=0.0160). Infants who died within 72 hours after birth had significantly higher CK-BB activity(130.2¡¾108.4U/L) than survivors(80.5¡¾161.1U/L), (p= 0.0209) 4) Infants who died within 24 hours after birth had significantly higher CK-BB%(23.4¡¾17.4%) than survivors(9.6¡¾11.9%), (p=0.0042). Infants who died within 72 hours after birth had significantly higher CK-BB%(20.0¡¾15.4%) than survivors(9.3¡¾11.8%), (p= 0.0027). Infants who died within 28 days after birth had significantly higher CK-BB% (12.7¡¾13.4%) than survivors (9.7¡¾12.3%), (p=0.0500). 5) In the cases of neonatal seizure in 24-48 hours after birth, CK-BB was higher than in the cases of no seizure or seizure in 48 hours after birth. 6) CK-BB was well correlated to the grade of hypoxic ischemic encephalopathy. 7) CK-BB, CK-BB% and 5 minute Apgar score showed similar positive and negative predictive values for survival rate, abnormal findings of imaging studies and neurologic outcomes.
Conclusion
: CK-BB is a good predictive value for the death within 24 and 72 hours after birth and the neonatal seizure in 24-48 hours after birth. CK-BB% is a good predictive value of the death within 24, 72 hours and 28 days after birth. CK-BB, CK-BB% and 5 minute Apgar score showed similar predictivity for neurologic outcomes during 1 years after birth.

Keywords :Creatine kinase(CK), Isoenzyme, CK-BB, Perinatal or birth asphyxia