Accuracy Of Umbilical Cord Blood Lactate Dehydrogenase Levels Versus Umbilical Cord Blood Ph in Neonates with Birth Asphyxia: A Cross-Sectional Study

Background: Birth asphyxia remains a major cause of neonatal morbidity and mortality worldwide, particularly in developing countries. Early identification of hypoxic injury is essential for timely management and prevention of long-term neurological sequelae. Umbilical cord blood pH is commonly used to assess fetal metabolic status at birth; however, biochemical markers such as lactate dehydrogenase (LDH), which reflect cellular injury, may serve as useful adjunct indicators of hypoxic insult.

Objective: To evaluate the diagnostic accuracy of umbilical cord blood lactate dehydrogenase (LDH) levels compared with umbilical cord blood pH in neonates with birth asphyxia.

Methods: This hospital-based cross-sectional study was conducted in a tertiary care hospital over a two-year period. A total of 75 neonates diagnosed with birth asphyxia were included in the study. Umbilical cord arterial blood samples were collected immediately after delivery for measurement of cord blood pH using a blood gas analyzer and LDH levels using an automated biochemical analyzer. Serum LDH levels were also estimated. Demographic and clinical variables were recorded. Statistical analysis was performed using appropriate tests including the Chi-square test, and a p-value <0.05 was considered statistically significant.

Results: Among the 75 neonates included in the study, 61.3% were males and 38.7% were females. The majority of neonates were term (58.7%), while 41.3% were preterm. Mild acidemia (pH >7.2) was observed in 57.3%, moderate acidemia (pH 7.01–7.19) in 32.0%, and severe acidemia (pH <7.0) in 10.7% of neonates. Elevated cord LDH levels (>612 IU/L) were significantly associated with decreasing cord blood pH values. A significant association was observed between cord blood pH and cord LDH levels (p = 0.004) as well as between cord blood pH and serum LDH levels (p = 0.001). Higher LDH levels were observed in neonates with severe acidemia, suggesting greater cellular injury due to hypoxia.

Conclusion: Umbilical cord blood LDH levels showed a significant association with cord blood pH and the severity of metabolic acidosis in neonates with birth asphyxia. Elevated LDH levels may serve as a useful adjunct biochemical marker for early detection and assessment of neonatal hypoxia, particularly in settings where cord blood gas analysis is not readily available