The Indian Journal of Pediatrics

, Volume 81, Issue 3, pp 248–253

Prooxidant-Antioxidant Balance in Perinatal Asphyxia

  • Hassan Boskabadi
  • Abbas Navaee Boroujeni
  • Hesam Mostafavi-Toroghi
  • Golkoo Hosseini
  • Majid Ghayour-Mobarhan
  • Dariush Hamidi Alamdari
  • Mahtab Biranvandi
  • Hamidreza Saber
  • Gordon A. Ferns
Original Article



To determine the prooxidant-antioxidant balance (PAB) in neonatal asphyxia and compare it with values for PAB in healthy neonates.


In a prospective observational study, serum PAB of umbilical cord blood of 30 neonates with asphyxia [pH < 7.2, low Apgar score, signs of respiratory distress syndrome (RDS)] as the case group and 35 healthy neonates (without an abnormal clinical event at birth and after the first week) as the control group were compared.


Among the 35 neonates in the control group, the average level of serum PAB was 20.00 HK units, which was significantly lower than for the 30 neonates within the case group (40.46 HK units; p = 0.019). The blood pH in the case group was significantly lower than for control group (P < 0.001). In controls, HCO3- and pCO2 were 18.6 mmol/L and 38.5 mmHg respectively, whilst in the case group these values were 15.5 mmol/L and 45.7 mmHg respectively (p < 0.05).


Determination of PAB may be useful in the early diagnosis of perinatal asphyxia and is consistent with HCO3-, pCO2 and Apgar score.


Asphyxia neonatorum Hypoxia-ischemia Brain Reactive oxygen species Antioxidants Oxidative stress 


  1. 1.
    Low JA. The role of blood gas and acid–base assessment in the diagnosis of intrapartum fetal asphyxia. Am J Obstet Gynecol. 1988;159:1235–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362:65–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Oswyn G, Vince JD, Friesen H. Perinatal asphyxia at Port Moresby General Hospital: A study of incidence, risk factors and outcome. P N G Med J. 2000;43:110–20.PubMedGoogle Scholar
  4. 4.
    Levene ML, Kornberg J, Williams TH. The incidence and severity of post-asphyxial encephalopathy in full-term infants. Early Hum Dev. 1985;11:21–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: Incidence, clinical course and outcome in a Swedish population. Acta Paediatr. 1995;84:927–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Azzopardi DV, Strohm B, Edwards AD, Dyet L, Halliday HL, Juszczak E, et al; TOBY Study Group. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med. 2009;361:1349–58.Google Scholar
  7. 7.
    Reddy S, Dutta S, Narang A. Evaluation of lactate dehydrogenase, creatine kinase and hepatic enzymes for the retrospective diagnosis of perinatal asphyxia among sick neonates. Indian Pediatr. 2008;45:144–7.PubMedGoogle Scholar
  8. 8.
    Boskabadi H, Maamouri G, Sadeghian MH, Ghayour-Mobarhan M, Heidarzade M, Shakeri MT, et al. Early diagnosis of perinatal asphyxia by nucleated red blood cell count: A case–control study. Arch Iran Med. 2010;13:275–81.PubMedGoogle Scholar
  9. 9.
    Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns. Int J Gynaecol Obstet. 2003;81:267–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Hill A, Volpe JJ. Perinatal asphyxia: Clinical aspects. Clin Perinatol. 1989;16:435–57.PubMedGoogle Scholar
  11. 11.
    Hankins GD, Speer M. Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. Obstet Gynecol. 2003;102:628–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Kumar A, Ramakrishna SV, Basu S, Rao GR. Oxidative stress in perinatal asphyxia. Pediatr Neurol. 2008;38:181–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Scher M. Perinatal asphyxia: Timing and mechanisms of injury in neonatal encephalopathy. Curr Neurol Neurosci Rep. 2001;1:175–84.PubMedCrossRefGoogle Scholar
  14. 14.
    Cheeseman KH, Slater TF. An introduction to free radical biochemistry. Br Med Bull. 1993;49:481–93.PubMedGoogle Scholar
  15. 15.
    Southorn PA, Powis G. Free radicals in medicine. I. Chemical nature and biologic reactions. Mayo Clin Proc. 1988;63:381–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Alamdari DH, Paletas K, Pegiou T, Sarigianni M, Befani C, Koliakos G. A novel assay for the evaluation of the prooxidant-antioxidant balance, before and after antioxidant vitamin administration in type II diabetes patients. Clin Biochem. 2007;40:248–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Martín-Ancel A, García-Alix A, Gayá F, Cabañas F, Burgueros M, Quero J. Multiple organ involvement in perinatal asphyxia. J Pediatr. 1995;127:786–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Garzoli E, Monteleone M, Migliori C, Abrami F. Umbilical acid–base status of term infants: Correlation with delivery mode. Pediatr Med Chir. 2007;29:202–5.PubMedGoogle Scholar
  19. 19.
    Chen ZL. Multicenter clinical study on umbilical cord arterial blood gas parameters for diagnosis of neonatal asphyxia. Zhonghua Er Ke Za Zhi. 2010;48:668–73.Google Scholar
  20. 20.
    Gao C, Yuan L, Wang J. Role of pH value of umbilical artery blood in neonatal asphyxia. Zhongguo Dang Dai Er Ke Za Zhi. 2009;11:521–4.PubMedGoogle Scholar
  21. 21.
    McGuire W. Perinatal asphyxia. Clin Evid (Online). 2007;2007. pii: 0320.Google Scholar
  22. 22.
    Shoji H, Shimizu T. Antioxidative properties of human milk and spermine are not related to expression of Hsp 70. Acta Paediatr. 2008;97:81–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Aydemir O, Akar M, Uras N, Eras Z, Erdeve O, Oguz SS, et al. Total antioxidant capacity and total oxidant status in perinatal asphyxia in relation to neurological outcome. Neuropediatrics. 2011;42:222–6. doi:10.1055/s-0031-1295480.PubMedCrossRefGoogle Scholar
  24. 24.
    Alamdari DH, Ghayour-Mobarhan M, Tavallaie S, Parizadeh MR, Moohebati M, Ghafoori F, et al. Prooxidant-antioxidant balance as a new risk factor in patients with angiographically defined coronary artery disease. Clin Biochem. 2008;41:375–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Ghayour-Mobarhan M, Alamdari DH, Moohebati M, Sahebkar A, Nematy M, Safarian M, et al. Determination of prooxidant—antioxidant balance after acute coronary syndrome using a rapid assay: A pilot study. Angiology. 2009 Dec–2010 Jan;60:657–62.Google Scholar
  26. 26.
    Koliakos GG, Befani CD, Mikropoulos D, Ziakas NG, Konstas AG. Prooxidant-antioxidant balance, peroxide and catalase activity in the aqueous humour and serum of patients with exfoliation syndrome or exfoliative glaucoma. Graefes Arch Clin Exp Ophthalmol. 2008;246:1477–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Parizadeh SM, Azarpazhooh MR, Moohebati M, Nematy M, Ghayour-Mobarhan M, Tavallaie S, et al. Simvastatin therapy reduces prooxidant-antioxidant balance: Results of a placebo-controlled cross-over trial. Lipids. 2011;46:333–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Boskabadi H, Moeini M, Tara F, Tavallaie S, Saber H, Nejati R, et al. Determination of prooxidant–antioxidant balance during uncomplicated pregnancy using a rapid assay. J Med Biochem. 2013;32:227–32.CrossRefGoogle Scholar
  29. 29.
    Tara F, Rayman MP, Boskabadi H, Ghayour-Mobarhan M, Sahebkar A, Alamdari DH, et al. Prooxidant-antioxidant balance in pregnancy: a randomized double-blind placebo-controlled trial of selenium supplementation. J Perinat Med. 2010;38:473–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Parizadeh MR, Azarpazhooh MR, Mobarra N, Nematy M, Alamdari DH, Tavalaie S, et al. Prooxidant-antioxidant balance in stroke patients and 6-month prognosis. Clin Lab. 2011;57:183–91.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2013

Authors and Affiliations

  • Hassan Boskabadi
    • 1
  • Abbas Navaee Boroujeni
    • 1
  • Hesam Mostafavi-Toroghi
    • 2
  • Golkoo Hosseini
    • 2
  • Majid Ghayour-Mobarhan
    • 2
  • Dariush Hamidi Alamdari
    • 2
  • Mahtab Biranvandi
    • 3
  • Hamidreza Saber
    • 2
  • Gordon A. Ferns
    • 4
  1. 1.Neonatal Research Center, School of MedicineMashhad University of Medical SciencesMashhadIran
  2. 2.Biochemistry of Nutrition Research Center, School of MedicineMashhad University of Medical SciencesMashhadIran
  3. 3.Gynecology Hospital, School of MedicineMashhad University of Medical SciencesMashhadIran
  4. 4.Division of Medical EducationBrighton and Sussex Medical SchoolBrightonUK

Personalised recommendations