Significance Of Changes In Cerebrospinal Fluid CAMP In Neonatal Hypoxic-ischemic Encephalopathy

Significance of changes in cerebrospinal fluid cAMP in neonatal hypoxic-ischemic encephalopathyMaster Candidate: Huang GuocongSupervisor: Chen Hanqiang Director Associate Professor Department of Neonatology, Women and Children Health Hospital of Fujian Province.Objective: To investigate the role of cerebrospinal fluid cAMP in hypoxic-ischemic brain damage and the relationship to the neurodevelopmental outcome.Methods: CSF cAMP was measured by using radioimmunoassay procedures in 86 neonates with hypoxic-ischemic encephalopathy ( 26 cases of mild, 35 cases of moderate, and 25 cases of severe status ) both acute and recovery phases.Results: CSF cAMP levels in infants with HIE both acute and recovery phase were significantly lower than those in controls, and there was a good negative correlation between the severity of illness and CSF cAMP concentrations. The CSF cAMP levels were significantly lower in severe HIE groups compared to mild andmoderate HIE groups. In recovery phase, the CSF cAMP levels in all three groups of the HIE infants increased, which were no significant differences in compared with those in acute phase. Among 86 infants with HIE. 5 died and 22 had abnormal outcomes. Univariate analysis showed that abnormal outcomes were significantly related to CSF cAMP levels, Phenobarbital use, seizures, multiorgan failure, and HIE stage. However, only CSF cAMP was retained in the model by stepwise logistic regression.CSF cAMP of 13.5pmol/ml discriminated between those with normal and those with abnormal neurologic outcome. Low CSF cAMP concentration was associated with abnormal long-term outcome, estimated odds ratio of 13.51 ( 95%CI 4.26-142.87, P<0.01 ) , and sensitivity, specificity, positive and negative predictive values of 70%, 87%, 86% and 89%, respectively.Conclusion: CSF cAMP concentrations were decreased in infants with HIE. Low CSF cAMP levels were associated with poor neurologic outcome.