Hepatic enzyme alterations as prognostic markers in neonates with hypoxic-ischemic encephalopathy: A hospital-based prospective cohort study.

Eaka  Mahesh; Ragini  Mutukulla; Durgesh  Velupula; Bindhu  Vechangi

doi:10.51168/sjhrafrica.v6i6.1794

Authors

Dr . Eaka Mahesh Assistant professor, Department of Pediatrics, Kakatiya Medical College, Warangal, Telangana, India
Dr. Ragini Mutukulla Associate Professor, Department of Pediatrics, Government Medical College, Siddippet, Telangana, India
Dr . Durgesh Velupula Assistant professor, Department of Pediatrics, Government Medical College, Mahabubabad, Telangana, India
Dr. Bindhu Vechangi Assistant professor, Department of Pediatrics, Government Medical College, Narsampet, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1794

Keywords:

Hypoxic-ischemic encephalopathy, perinatal asphyxia, liver enzymes, SGOT, SGPT, ALP, neonatal prognosis, Sarnat staging

Abstract

Background
Perinatal asphyxia remains a significant contributor to neonatal morbidity and mortality, with hypoxic-ischemic encephalopathy (HIE) being a major sequela. Liver injury is a common systemic complication, and hepatic enzymes may serve as potential biomarkers for the severity of hepatic encephalopathy (HIE).

Objectives: To assess the pattern of hepatic enzyme alterations in neonates with HIE and explore their prognostic value in stratifying disease severity.

Methods
This prospective cohort study enrolled 100 term neonates with perinatal asphyxia. HIE staging was performed using the modified Sarnat and Sarnat criteria. Liver function tests, including serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), and alkaline phosphatase (ALP), were measured on Days 1 and 3. Statistical analysis included ANOVA, post-hoc comparisons, and Chi-square tests to evaluate associations with clinical outcomes.

Results
Among the neonates, 33% had HIE Stage I, 39% Stage II, and 28% Stage III. Serial measurements showed significant increases in SGOT, SGPT, and ALP from Day 1 to Day 3 across all HIE stages (p<0.001). Enzyme elevations were most marked in Stage III. Cut-off values for predicting Stage III HIE were SGOT >77.4 U/L, SGPT >90.4 U/L, and ALP >257.1 U/L. Seizure activity (p<0.001) and mode of resuscitation (p<0.001) showed statistically significant associations with HIE severity, while maternal risk factors (p=0.72), mode of delivery (p=0.64), and place of delivery (p=0.59) did not.

Conclusion
Serial hepatic enzyme levels are reliable biochemical indicators for assessing the severity of HIE. Their prognostic relevance supports early stratification and targeted management in neonatal intensive care units.
Recommendations

Regular monitoring of hepatic enzymes in neonates with perinatal asphyxia can aid early detection and management of HIE severity.

Author Biographies

Dr . Eaka Mahesh, Assistant professor, Department of Pediatrics, Kakatiya Medical College, Warangal, Telangana, India

Dr.Eaka Mahesh is currently working as an Assistant Professor in the Department of Paediatrics, Kakatiya Medical College, Warangal. He completed MBBS from Gandhi Medical College, Secunderabad, and MD Paediatrics from Osmania Medical College. Actively Participates in Undergraduate Teaching. Passionate about Medical Education and Research.ORCID ID:https://orcid.org/0009-0006-9886-1061

Dr. Ragini Mutukulla, Associate Professor, Department of Pediatrics, Government Medical College, Siddippet, Telangana, India

Dr. Ragini Mutukulla is currently working as an Associate Professor at the Government Medical College, Siddipet, Telangana, India. She completed her MBBS from Osmania Medical College, Hyderabad, and her MD in Pediatrics from Niloufer Hospital, Osmania Medical College, Hyderabad. Worked as Assistant Professor of Pediatrics in the Government maternity hospital, Sultanbazar/Osmania medical college. With over 7 years of experience, she has successfully guided both undergraduate and postgraduate students. She has published over 6 scientific research papers in various journals in the field of Pediatrics. ORCID ID:https://orcid.org/0000-0001-8115-4439

Dr . Durgesh Velupula, Assistant professor, Department of Pediatrics, Government Medical College, Mahabubabad, Telangana, India

Dr.Durgesh Velpula is currently working as an Assistant Professor in the Department of Paediatrics at Government Medical College, Mahabubabad. He completed MBBS from Mamatha Medical College, MD Paediatrics from Kakatiya Medical College, Warangal.

Enthusiastic and actively participated in Academic Activities during the UG and PG period. He has helped in research publications during his career. Completed TOT training related to Medical Education and Health programs. ORCID ID:https://orcid.org/0009-0001-0451-571X

Dr. Bindhu Vechangi, Assistant professor, Department of Pediatrics, Government Medical College, Narsampet, Telangana, India

Dr.Bindhu Vechangi is Currently Working as an Assistant professor in the department of Paediatrics at Government Medical College, Narsampet. She completed MBBS from Andhra Medical College, Visakhapatnam, Andhra Pradesh, and MD Paediatrics from AIIMS Rishikesh, and Senior Residency from AIIMS Rishikesh. She has published Case series and Research Articles in her Career and is Passionate to so in the future.ORCID ID:https://orcid.org/0009-0009-2383-8504

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