Published: 2020-05-22

Urinary uric acid or urinary creatinine ratio as a non-invasive marker for perinatal asphyxia

Siddharth ., Preeti Lata Rai, P. L. Prasad


Background: Perinatal asphyxia is amongst the common problem of neonates and there exists a significant contribution to the neonatal morbidity and mortality. It is observed as a common and a vital cause of the preventable cerebral injury. The prediction of the perinatal asphyxial outcome is very important but dreadful. There is a limited role for APGAR score to predict the immediate outcome, like HIE and the long-term neurological sequelae observational error may happen in APGAR. But the biochemical parameters can truly be relied upon. This study was done to assess urinary uric acid/urinary creatinine ratio (UA/Cr) as a non-invasive marker for perinatal asphyxia and co-relate its absolute value to the degree of the perinatal asphyxia.

Methods: In this prospective case control study conducted in the Pediatrics Department of Shri Ram Murti Smarak Institute of Medical Sciences between Nov 2017 to May 2019, 42 asphyxiated and 42 non-asphyxiated newborns were included. Detailed history and assessment were for all the enrolled newborns. Spot urine samples were sent for the uric acid and creatinine estimation. Results were documented, and statistical analysis was performed.

Results: Urinary uric acid to creatinine ratio used as additional non-invasive, early and easy biochemical marker of the birth asphyxia that biochemically supports severity grading and clinical diagnosis of the asphyxia by APGAR score.

Conclusions: The ratio of the urinary uric acid and creatinine enables rapid and early recognition of asphyxial injury and also the evaluation of its severity and potential for short-term morbidity or death.


APGAR score, Perinatal asphyxia, Hypoxic ischemic encephalopathy, Urinary uric acid/creatinine ratio

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Sreekrishna Y, Eregowda A, Sharma AHL. Study of urinary uric acid to creatinine ratio as a biochemical marker of perinatal asphyxia and its correlation with Apgar Score. Int J Contemp Pediatr. 2018;5:1485-9.

Network NN. National Neonatal-Perinatal Database (Report 2002–2003). New Delhi, India: Department of Pediatrics, All India Institute of Medical Sciences. 2005.

Reddy S, Reddy N, Nagasravani J, Nasir M. Incidence of Acute Renal Failure in Birth Asphyxia and its Correlation with Hypoxic Ischemic Encephalopathy (HIE). Inter J Med Res Health Sci. 2017;6(4):80-91

American Academy of Pediatrics. The APGAR score. Advances in Neonatal Care. 2006;6(4):220-3.

Patel KP, Makadia MG, Patel VI, Nilayangode HN, Nimbalkar SM. Urinary Uric Acid/Creatinine Ratio – A Marker For Perinatal Asphyxia. J Clini Diagnostic Res. 2017;11(1):SC08-SC10.

Futrakul S, Praisuwanna P, Thaitumyanon P. Risk factors for hypoxic ischemic encephalopathy in asphyxiated newborn infants. J Med Assoc Thai. 2006;89(3):322-8.

NCCLS National committee for clinical laboratory standards. Procedures for the handling and processing of blood specimen approved guidelines NCCLS. 1990;18.

Bhongir AV, Varma A, Yakama V, Saha S, Radia SB, Pabbati J. The Urinary Uric Acid/Creatinine Ratio is An Adjuvant Marker for Perinatal Asphyxia. Eur J Pharm Med Res. 2015;2(5):520-8.

Bohr L, Greisen G. Prognosis after perinatal asphyxia in full-term infants. A literature review. Ugeskr Laeger. 1998;160:2845-50.

Krishnana E, Ponnusamy V, Sekar SP. Study of urinary uric acid and creatinine ratio as a marker of neonatal asphyxia for babies born in a tertiary care hospital. Int J Res Med Sci. 2017;5:5418-23.

Basu P, Som S, Choudhuri N. Correlation between APGAR Score and urinary uric acid and creatinine ratio as a marker of perinatal asphyxia. Ind J Clin Biochem. 2008;23:361-4.

Bader D, Gozal D, Weinger-Abend M, Berger A. Neonatal urinary uric acid and creatinine ratio as additional marker of perinatal asphyxia. Eur J Pediatr. 1995;154:747-9.

Chen HJ, Yau KI, Tsai KS. Urinary uric uric acid/creatinine ratio as an additional marker of perinatal asphyxia. J Formos Med Assoc. 2000;99:771-4.

Akisu M, Kultursay N. value of urinary uric acid to creatinine ratio in term infants with perinatal asphyxia. Acta Paediatr Jpn. 1998;40:78-81.

Wen-Ben D, Young-Lun H, Hong-Ying C. Change of the Urinary Uric acid/creatinine ratio in neonates with Asphyxia. Chin J Contemp Pediatr. 2002;4(5):1-3.

Yashwanth K, Babu MS, Srinivas K. A study of urinary uric acid to creatinine ratio in assessing the severity of birth asphyxia. IOSR J Dent Med Sci. 2017;16(10):69-76

Bahubali DG, Bhat Vishnu B, Ramachandra R, Adhisivam B, Rojo J, Prasad P, et al. Biochemical marker as predictor of outcome in perinatal asphyxia. Cur Ped Res. 2013;17(2).

Banupriya C, Doureradjou P, Mondal N, Vishnu B, Koner BC. Can urinary excretion rate of malondialdehyde, uric acid and protein predict the severity and impending death in perinatal asphyxia? Clin Biochem. 2008;41(12):968-73.

Nariman S, Mosayebi Z, Sagheb S, Rastad H, Hosseininodeh SS. urinary Uric Acid/ Creatininine Ratio as aMarker of Mortality and Unfavorable Outcome in NICU–Admitted Neonates. Iran J Pediatr. 2016;26(4):e5739.

Choudhary L, Palsania S,Berwal PK, Sauparna C, Maheshwari A. Study of Urinary Uric Acid and Creatinine Ratio as a Marker of Perinatal Asphyxia and Its Correlation with Different Stages of Hypoxic Ischemic Encephalopathy. J Preg Child Health. 2017;4(3):1000336.

Kumar D, Chaudhari PK, Chaudhary AK, Kamal S. Urinary Uric Acid and Creatinine Ratio As A Marker of Perinatal Asphyxia. IOSR J Dent Med Sci. 2016;15(6):13-5.