Serum and Urinary Uric Acid and Creatinine Ratio as a Biomarker in Perinatal Asphyxia: A Prospective Observational Study

Introduction: Perinatal asphyxia is a major problem that substantially increases newborn morbidity and mortality. It is defined as the inability to establish breathing at birth. An estimated 23% of the approximately four million neonatal deaths and 26% of the 3.2 million stillbirths worldwide each year are due to perinatal asphyxia. Aim: To determine serum uric acid, creatinine, urinary uric acid, and creatinine levels in neonates with perinatal asphyxia. Materials and Methods: This was a prospective observational study conducted in a Level III-A Neonatal Intensive Care Unit (NICU), Department of Paediatrics, Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, from March 2023 to November 2024, with a sample size of 129 neonates. Renal parameters were assessed between 24 and 48 hours of life. The study included neonates born at ≥37 weeks’ gestation with an Apgar score ≤7. Variables such as duration of oxygen therapy, renal function, length of NICU stay, duration of respiratory support (including mechanical ventilation) and complications during NICU stay were evaluated. Associations among qualitative variables were analysed using the Chi-squared test, and differences between quantitative groups were assessed using the t-test, with a significance level set at 5%. Results: A significant association was observed between low Apgar scores at five minutes and elevated levels of serum and urinary biomarkers. Elevated serum and urinary UA/Cr ratios were significantly associated with lower Apgar scores (p-value <0.001). Both serum UA/Cr and urinary UA/Cr ratios were markedly elevated in neonates with lower Apgar scores, reinforcing their potential as early indicators of the severity of perinatal asphyxia. Conclusion: Serum and urinary UA/Cr ratios show potential as biomarkers for perinatal asphyxia severity.