Prognostic significance of cerebrospinal fluid cyclic adenosine monophosphate in neonatal asphyxia

Massroor Pourcyrous, Henrietta S. Bada, Wenjian Yang, Helena Parfenova, Seok P. Wong, Sheldon B. Korones, Charles W. Leffler

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: In piglets prolonged asphyxia resulted in decreased cerebrospinal fluid (CSF) 3,5'-cyclic adenosine monophosphate (cAMP) during recovery; this was associated with reduced pial arteriolar responses to stimuli that use cAMP as a second messenger. We hypothesized that asphyxia in human neonates results in decreased CSF cAMP and that low CSF cAMP is associated with abnormal outcome. Design: We studied 27 infants with evidence of hypoxic-ischemic insult; 19 were term (group 1) and 8 were preterm (group 2). The normal values of CSF cAMP were determined from 75 infants with no asphyxia; 44 were term (group 3) and 31 were preterm (group 4). CSF cAMP was measured by using radioimmunoassay procedures. Results: CSF cAMP levels in infants with asphyxia (groups 1 and 2) were 12 ± 9.5 and 7.9 ± 7.1 pmol/mL, respectively, significantly lower than those of groups 3 and 4 (control infants), that is, 21.1 ± 8.7 and 27.1 ± 9.2 pmol/mL, respectively (P < .0001). Among infants with asphyxia, 3 died and 10 had abnormal neurologic outcome. Univariate analysis showed that abnormal outcomes were significantly related to CSF cAMP levels, phenobarbital use, and multi-organ failure. However, only CSF cAMP was retained in the model by stepwise logistic regression. CSF cAMP of 10.0 pmol/mL discriminated between those with normal and those with abnormal neurologic outcome. Low CSF cAMP concentration was associated with abnormal long-term outcome, estimated odds ratio of 12.4 (95% CI, 2.1-109.3; P < .006), and sensitivity, specificity, and positive and negative predictive values of 85%, 69%, 73%, and 80%, respectively. Conclusion: CSF cAMP concentrations were decreased in infants with asphyxia. Low CSF cAMP levels were associated with poor neurologic outcome.

Original languageEnglish
Pages (from-to)90-96
Number of pages7
JournalJournal of Pediatrics
Issue number1
StatePublished - 1999

Bibliographical note

Funding Information:
Supported in part by grants-in-aid from the American Heart Association-Tennessee Affiliate, the National Institutes of Health, the Obstetrics and Gynecology Special Education Fund, the Le Bonheur Children’s Medical Center Small Grants, and a fund from UT Medical Group research grants program.

Copyright 2017 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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