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Lipid peroxides (LPOs) are released when free radicals react with unsaturated fatty acids in cell membranes during hypoxic ischemic insult in neonates. We aimed to assess LPO concentrations in the serum of asphyxiated and non-asphyxiated neonates and examine their correlation with the severity of asphyxia.This prospective cross-sectional study was conducted on a group of asphyxiated neonates and controls. Serum LPO concentrations was measured by enzyme-linked immunosorbent assay at 4-6 h of life in all subjects. Encephalopathy was classified according to Sarnat's stages into mild, moderate and severe at 12-24 h of life. LPO was compared between groups and was correlated with severity of encephalopathy and mortality.A total of 90 infants were enrolled; of them 45 had asphyxia. Serum LPO (nmol ml- 1) was significantly greater in the asphyxia group (6.9 ± 3.01 vs 1.78 ± 1.09, P < 0.001). It correlated positively with severity of encephalopathy (P < 0.001) and negatively with Apgar score at 5 min (r = - 0.532, P < 0.001) and with initial blood gases pH (r = - 0.664, P < 0.001). LPO measured greater concentrations in infants who died compared with asphyxiated survivors (11.64 ± 1.31 vs 6.18 ± 2.48, P = 0.0004).LPO was increased and correlated with severity of asphyxia as well as with mortality. Further studies are warranted to examine whether it is only a marker for outcome or a contributor in the pathogenesis of hypoxic-ischemic brain injury.