The value of brain-typical creatine phosphokinase iso-enzyme (CPK-BB) determinations in the assessment of brain damage due to neonatal asphyxia in 33 full-term infants has been assessed in the Services of Neonatology, Child Neurology and Radiology, Clinica Infantil, Cindad Sanitaria “La Paz“, Madrid, Spain. Serum CPK activities measured at 4 hrs after birth were significantly higher in infants who died of HIE or developed neurological sequelae than in those asphyxiated infants who showed no neurological abnormalities during a 16 mo follow-up period or in a control group of 20 infants delivered normally. At 10 hrs after birth, the enzyme levels in brain damaged infants had decreased markedly and overlapped with values obtained in infants without sequelae at follow-up. Compared to the neurological exams, EEG’s, and CT scans, obtained in the first or second week of life, the CPK assay was inferior as a predictor of neurological outcome. Normal CPK, CT and EEG’s, and mild clinical encephalopathy were 96-100% predictive of a favorable outcome in asphyxiated full-term infants. [1]

COMMENT. In this study, an elevated serum CPK measured within 4 hrs after birth was a sensitive indicator of brain damage in asphyxiated term infants but was of limited prognostic value in assessment of neurological outcome. These results contrast with those reported by Walsh P [2], who found that serum CPK-BB activity measured in cord blood and at 6-12 hrs of life correlated with neurological outcome after severe asphyxia and compared favorably with CT scanning as a prognostic indicator. Normal CPK-BB activity was a predictor of good neurologic outcome in both studies (see Ped Neur Briefs 1987;1(3) :17).