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Urinary Thiobarbituric Acid–Reacting Substances as Potential Biomarkers of Intrauterine Hypoxia
Ann Siciarz, MD;
Barry Weinberger, MD;
Gisela Witz, PhD;
Mark Hiatt, MD;
Thomas Hegyi, MD
Arch Pediatr Adolesc Med. 2001;155:718-722.
Background Currently available clinical tools cannot accurately identify the extent
of perinatal hypoxic injuries. During hypoxia, reactive oxygen species cause
lipid peroxidation of cell membranes, yielding oxidation products that constitute
thiobarbituric acid–reacting substances (TBARS).
Objective To see if the concentrations of TBARS excreted in urine would be elevated
during the first day of life in term and preterm infants following chronic
hypoxia or acute asphyxia.
Design Thiobarbituric acid–reacting substances levels were measured by
a spectrophotometric assay in urine samples collected from term and near-term
( 34 weeks gestation, n = 22), and preterm (<34 weeks gestation, n
= 52) infants on the first day of life.
Patients Infants were admitted to the St Peter's University Hospital (New Brunswick,
NJ) neonatal intensive care unit from July 1997 to January 1999. Acute asphyxia was defined as umbilical cord blood pH values less than
7.05, or Apgar scores of less than 5 at 5 minutes. Chronic
hypoxia was defined as intrauterine growth retardation or low birth
weight (small for gestational age) associated with pregnancy-induced hypertension
or reversal of umbilical arterial blood flow.
Results Among term infants, urinary TBARS levels were significantly increased
following acute asphyxia (P = .02). Levels of TBARS
also tended to be elevated following chronic hypoxia. Urinary TBARS levels
in term infants tended to be increased in those requiring mechanical ventilation
(P = .05) or delivery room resuscitation (P = .15), as well as in those passing intrauterine meconium (P = .13) or having clinical evidence of hypoxic-ischemic
encephalopathy (P = .24).
Conclusions The results show a correlation between elevated urinary TBARS levels
in term and near-term infants, and perinatal hypoxia (as determined by low
Apgar scores or umbilical cord blood acidosis). We speculate that TBARS concentrations
may be useful as a biomarker for perinatal hypoxic injury in newborns. Further
studies are needed to determine whether elevations in TBARS levels are better
predictors of the extent of hypoxic injury than existing markers.
From the Division of Neonatology,
Department of Pediatrics, UMDNJ–Robert Wood Johnson Medical School, St
Peter's University Hospital, New Brunswick, NJ (Drs Siciarz,
Weinberger, Hiatt, and Hegyi), and the Department of Environmental and
Community Medicine, UMDNJ–Robert Wood Johnson Medical School,
Piscataway, NJ (Dr Witz).
Corresponding author and reprints: Barry Weinberger, MD, Division
of Neonatology, St Peter's University Hospital, 254 Easton Ave, New Brunswick,
NJ 08903 (e-mail: barryw{at}pol.net).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
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Goodyear-Bruch and Pierce
Am J Crit Care 2002;11:543-551.
ABSTRACT
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