| PrefaceHypoxic - ischemic encephalopathy ( HIE) resulted from perinatal asphyxia. HIE is an important cause of neonatal mortality and of subsequent neurologic disabilities among the infants who survive.Hypoxia and/or ischemia can cause lactate increased. At the present, 1 H - MRS analysis found Lac levels in brain were correlated with neurologic outcome; Epo was present in the CNS and CSF Epo levels were significantly higher in asphyxic infants; Epo protected neural cells from HI damage. The objectives of our experiment were to observe the changes of Epo and Lac levels in blood and CSF of HIE infants , and to determine the relationship between Epo, Lac levels and HIE neurologic outcome.Patiarits and MethodsObjects: Two groups of infants were studied; (1) HIE group:26 newborn infants with acute birth asphyxia and in the following days developing HIE(8 cases of the mild, 10 cases of the moderate and 8 cases of the severe). All the patients received the same routine treatment. At the 7 ~ lOdays, 24 of the 26 infants with HIE had a MRI assessment. (2) Control group; 8 newborn infants were normal termnewborn infants. Whose gestational age from 38 weeks to 42 weeks, birth weight 2500 ~ 4000g. All the infants were treated in newborn ward of our hospital from June to December in 2001. The neonates who have the following situation were removed; (1)phemolytic disease (2)neonatal jaundice (3)maternal diabetes (4)maternal hypertension, hepatic or renal disease ﹎eningitis.Blood and CSF specimens: Venous blood'of all the patients were obtained at the 0 ~ 24hours, 48 ~ 72hours, 7 ~ 10days after birth, blood was spun (1500rpm for 15 min. ) , removed the serum and then stored at - 70 until analysis. At the same time artery blood heparin-ized were obtained to assay the blood gas and to obtain lactate levels. CSF samples were obtained from the neonates with HIE at the time of 48-72 hours after birth, one part CSF samples were stored at -70 , another part were assayed the CSF Lac levels.Sample assay: Epo levels of serum and CSF were assayed by the radio immunoassay, and lactate levels of plasma and CSF were assayed by the Nova Stat Profile M blood gas machine.Statistical analysis: Date were expressed as mean ?SD values; between the control and HIE group with standard F test, q test; linear regression between paired serum Epo /plasma lactate and CSF Epo/ lactate samples; CSF Epo, Lac and Apgar score were compared with t test; p value <0.05 was considered significant.Results(1) In the first 0-24 hours, 48 ~ 72 hours after birth the Lac levels of plasma in HIE infants were much higher than in control, but no difference among them were shown in the recovery phase (7 ~ 10days). The plasma lactate levels in the severe HIE were higher than in the mild and the moderate at the first day after birth, but not at the following days. The Lac levels of CSF in severe HIE higher than in the mild and the moderate HIE.(2) The Epo levels of serum in severe HIE were much higher than those in control, mild and moderate HIE. There was no significant difference of Epo levels between the mild and the moderate HIE. The Epo levels of CSF in the severe HIE were higher than those in the mild and moderate HIE infants, but no difference was shown between in the mild and the moderate HIE.(3) There was a linear positive correlation between CSF and serum Epo levels in the severe HIE infants(r =0. 76, p <0.05).(4) CSF Epo,Lac levels in the asphyxiated infants with Apgar score 5 or less at the fifth minute were higher than those with Apgar score more than 5(p < 0. 05). CSF Epo, Lac levels of HIE infants with severe findings on MRI were remarkable higher than those with mild and moderate findings on MRI.DiscussionsIt has been proved that lactate was an early marker of anaerobic metabolism. As the body status improved, plasma Lac removed from the body rapidly. Lactate only reflects status of newborn hypoxia in short time after birth. At the following days, plasma Lac reflects local tissue cycle, metabo...
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