Prognostic significance of cerebrospinal fluid cyclic adenosine monophosphate in neonatal asphyxia

Massroor Pourcyrous, Henrietta S. Bada, Wenjian Yang, Elena Parfenova, Seok P. Wong, Sheldon B. Korones, Charles Leffler

Research output: Contribution to journalArticle

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Abstract

Objective: In piglets prolonged asphyxia resulted in decreased cerebrospinal fluid (CSF) 3,5'-cyclic adenosine monophosphate (cAMP) during recovery; this was associated with reduced pial arteriolar responses to stimuli that use cAMP as a second messenger. We hypothesized that asphyxia in human neonates results in decreased CSF cAMP and that low CSF cAMP is associated with abnormal outcome. Design: We studied 27 infants with evidence of hypoxic-ischemic insult; 19 were term (group 1) and 8 were preterm (group 2). The normal values of CSF cAMP were determined from 75 infants with no asphyxia; 44 were term (group 3) and 31 were preterm (group 4). CSF cAMP was measured by using radioimmunoassay procedures. Results: CSF cAMP levels in infants with asphyxia (groups 1 and 2) were 12 ± 9.5 and 7.9 ± 7.1 pmol/mL, respectively, significantly lower than those of groups 3 and 4 (control infants), that is, 21.1 ± 8.7 and 27.1 ± 9.2 pmol/mL, respectively (P < .0001). Among infants with asphyxia, 3 died and 10 had abnormal neurologic outcome. Univariate analysis showed that abnormal outcomes were significantly related to CSF cAMP levels, phenobarbital use, and multi-organ failure. However, only CSF cAMP was retained in the model by stepwise logistic regression. CSF cAMP of 10.0 pmol/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 12.4 (95% CI, 2.1-109.3; P < .006), and sensitivity, specificity, and positive and negative predictive values of 85%, 69%, 73%, and 80%, respectively. Conclusion: CSF cAMP concentrations were decreased in infants with asphyxia. Low CSF cAMP levels were associated with poor neurologic outcome.

Original languageEnglish (US)
Pages (from-to)90-96
Number of pages7
JournalJournal of Pediatrics
Volume134
Issue number1
DOIs
StatePublished - Jan 1 1999

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Asphyxia
Cyclic AMP
Cerebrospinal Fluid
Nervous System
Second Messenger Systems
Phenobarbital
Radioimmunoassay
Reference Values
Logistic Models
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

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Prognostic significance of cerebrospinal fluid cyclic adenosine monophosphate in neonatal asphyxia. / Pourcyrous, Massroor; Bada, Henrietta S.; Yang, Wenjian; Parfenova, Elena; Wong, Seok P.; Korones, Sheldon B.; Leffler, Charles.

In: Journal of Pediatrics, Vol. 134, No. 1, 01.01.1999, p. 90-96.

Research output: Contribution to journalArticle

Pourcyrous, Massroor ; Bada, Henrietta S. ; Yang, Wenjian ; Parfenova, Elena ; Wong, Seok P. ; Korones, Sheldon B. ; Leffler, Charles. / Prognostic significance of cerebrospinal fluid cyclic adenosine monophosphate in neonatal asphyxia. In: Journal of Pediatrics. 1999 ; Vol. 134, No. 1. pp. 90-96.
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abstract = "Objective: In piglets prolonged asphyxia resulted in decreased cerebrospinal fluid (CSF) 3,5'-cyclic adenosine monophosphate (cAMP) during recovery; this was associated with reduced pial arteriolar responses to stimuli that use cAMP as a second messenger. We hypothesized that asphyxia in human neonates results in decreased CSF cAMP and that low CSF cAMP is associated with abnormal outcome. Design: We studied 27 infants with evidence of hypoxic-ischemic insult; 19 were term (group 1) and 8 were preterm (group 2). The normal values of CSF cAMP were determined from 75 infants with no asphyxia; 44 were term (group 3) and 31 were preterm (group 4). CSF cAMP was measured by using radioimmunoassay procedures. Results: CSF cAMP levels in infants with asphyxia (groups 1 and 2) were 12 ± 9.5 and 7.9 ± 7.1 pmol/mL, respectively, significantly lower than those of groups 3 and 4 (control infants), that is, 21.1 ± 8.7 and 27.1 ± 9.2 pmol/mL, respectively (P < .0001). Among infants with asphyxia, 3 died and 10 had abnormal neurologic outcome. Univariate analysis showed that abnormal outcomes were significantly related to CSF cAMP levels, phenobarbital use, and multi-organ failure. However, only CSF cAMP was retained in the model by stepwise logistic regression. CSF cAMP of 10.0 pmol/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 12.4 (95{\%} CI, 2.1-109.3; P < .006), and sensitivity, specificity, and positive and negative predictive values of 85{\%}, 69{\%}, 73{\%}, and 80{\%}, respectively. Conclusion: CSF cAMP concentrations were decreased in infants with asphyxia. Low CSF cAMP levels were associated with poor neurologic outcome.",
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AB - Objective: In piglets prolonged asphyxia resulted in decreased cerebrospinal fluid (CSF) 3,5'-cyclic adenosine monophosphate (cAMP) during recovery; this was associated with reduced pial arteriolar responses to stimuli that use cAMP as a second messenger. We hypothesized that asphyxia in human neonates results in decreased CSF cAMP and that low CSF cAMP is associated with abnormal outcome. Design: We studied 27 infants with evidence of hypoxic-ischemic insult; 19 were term (group 1) and 8 were preterm (group 2). The normal values of CSF cAMP were determined from 75 infants with no asphyxia; 44 were term (group 3) and 31 were preterm (group 4). CSF cAMP was measured by using radioimmunoassay procedures. Results: CSF cAMP levels in infants with asphyxia (groups 1 and 2) were 12 ± 9.5 and 7.9 ± 7.1 pmol/mL, respectively, significantly lower than those of groups 3 and 4 (control infants), that is, 21.1 ± 8.7 and 27.1 ± 9.2 pmol/mL, respectively (P < .0001). Among infants with asphyxia, 3 died and 10 had abnormal neurologic outcome. Univariate analysis showed that abnormal outcomes were significantly related to CSF cAMP levels, phenobarbital use, and multi-organ failure. However, only CSF cAMP was retained in the model by stepwise logistic regression. CSF cAMP of 10.0 pmol/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 12.4 (95% CI, 2.1-109.3; P < .006), and sensitivity, specificity, and positive and negative predictive values of 85%, 69%, 73%, and 80%, respectively. Conclusion: CSF cAMP concentrations were decreased in infants with asphyxia. Low CSF cAMP levels were associated with poor neurologic outcome.

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