CSF LACTATE DEHYDROGENASE PREDICTS SEVERE NEONATAL INTRAVENTRICULAR HEMORRHAGE

CSF LDH is elevated in neonatal IVH and may arise from cerebral injury (Engelke, 1983). To test the value of CSF LDH in detecting cerebral injury, a prospective study was carried out in 57 neonates ≤ 32 weeks gestation. Total CSF LDH and its isoenzymes were measured on admission and cranial ultrasound (US) was performed on day 1 and 3. Ultrasounds were graded normal, small-moderate IVH, moderate-large IVH with ventricular dilation or parenchymal extension. There was a significant correlation of CSF LDH with severity of US hemorrhage (p<.02), although CSF red and white cell counts and glucose did not correlate with IVH. Comparing patients with large IVH and ventricular dilation or parenchymal extension vs patients with normal US or small IVH, mean CSF LDH was 169 v. 49 U/L. LDH isoenzyme 2 also correlated with severity of IVH (p<.01). Elevated CSF LDH was also significantly related to mortality (p<.04). Mean LDH in patients who died compared to survivors was 174 v. 48 U/L. In addition, elevated LDH isoenzyme 1 correlated with mortality (p<.02). In conclusion, our results show an increase in CSF LDH in patients with IVH and ventricular dilation or parenchymal hemorrhage, which may reflect cerebral infarction. Elevated CSF LDH also correlated with risk of death. Follow-up testing will assess its predictive value for long term neurodevelopmental handicap.