The Effect of the Excretion of Calcium, Magnesium, and Phosphate on the Serum Levels of These Substances in Newborns Who Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy

The Effect of the Excretion of Calcium, Magnesium, and Phosphate on the Serum Levels of These Substances in Newborns Who Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of the Excretion of Calcium, Magnesium, and Phosphate on the Serum Levels of These Substances in Newborns Who Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy Osman Baştuğ, Bahadır İnan, Ahmet Özdemir, Binnaz Çelik, Funda Baştuğ, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-244271/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hypocalcemia, hypomagnesemia, and hyperphosphatemia are common electrolyte disturbances in perinatal asphyxia(PA). Different reasons have been proposed for these electrolyte disturbances. This study investigated the effect of the urinary excretion of calcium(Ca), magnesium(Mg), and phosphorus(P) on the serum levels of these substances in babies who were treated using therapeutic hypothermia for hypoxic ischemic encephalopathy(HİE) caused by PA. This study sheds light on the pathophysiology that may cause changes in the serum values of these electrolytes. Method: This study included 21 healthy newborns(control group) and 38 patients(HİE group) who had undergone therapeutic hypothermia due to HİE. Only infants with a gestational age of 36 weeks and above and a birth weight of 2000 g and above were evaluated. The urine and serum Ca, Mg, P, and creatinine levels of all infants were evaluated at 24, 48, and 72 hours. Results: The lower serum Ca value and the higher serum P value of the HİE group were found to be statistically significant compared to the control group. There was no significant difference in serum Mg values between the groups. However, hypomagnesemia was detected in five patients from the HİE group. The urine excretions of these substances, which were checked at different times, were found to be significantly higher in the HİE group compared to the control group. Conclusion: This study determined that the urinary excretion of Ca, Mg, and P has an effect on the serum Ca, Mg, and P levels of infants with HİE. Pediatrics Hypoxic Ischemic Encephalopathy Therapeutic Hypothermia Neonatal Calcium Phosphorus Magnesium Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Despite advancing technology and treatments, perinatal asphyxia (PA) and one of its consequences, hypoxic-ischemic encephalopathy (HIE), continue to be significant health problems in neonatal patients. Moderate and severe HIE is seen in 1 to 3 out of every 1000 live births in developed countries [1,2], and its frequency in Turkey is 2.6 out of every 1000 live births [3]. Therapeutic hypothermia (TH) is a treatment method proven to reduce mortality and morbidity in full-term and near-term babies with moderate and severe HIE [4]. PA is known to cause acute kidney injury [5], and studies have also shown that PA can cause hypocalcemia, hypomagnesemia, and hyperphosphatemia [6–8]. This suggests that the urinary excretion of these substances can affect the serum calcium (Ca), magnesium (Mg), and phosphorus (P) levels of infants that have undergone TH due to HIE. It is possible that tubular dysfunction due to PA may affect the excretion and serum levels of these elements. To the best of our knowledge, this study is the first of its kind, and thus fills a gap in the literature, it will help us understand the relationship between renal involvement and serum electrolyte concentrations. We aimed to evaluate the effect of Ca, Mg and P tubular excretions on the development of hypocalcemia, hypomagnesemia and hyperphosphatemia in patients who underwent TH for Grade 2–3 HIE. Materials And Methods This prospective study included 38 infants (HIE group) who underwent TH for the treatment of HIE between January 10 and August 10, 2019, in Kayseri City Hospital’s Neonatal Intensive Care Unit and 21 healthy newborns (control group). The newborns diagnosed with HIE were grouped according to modified Sarnat&Sarnat clinical staging criteria. As determined by clinical and laboratory data, whole-body TH treatment was applied to patients who met the diagnostic criteria for Stage 2 and 3 HIE using a TH Arctic Sun 5000 (produced by Medivance, Inc. of Louisville, Colorado) device. TH was started within the first six hours of the infant’s life. Body temperatures were monitored using a rectal probe. The infant was cooled rapidly, and their temperature was kept at 33.5 ± 0.2°C for 72 hours. Their temperature was then raised by 0.25° C/hour to be between 36.5 and 37.5°C within 12 hours. Along with the prenatal, natal, and postnatal histories of the patients included in the study, serum and spot urine Ca, Mg, P, and creatinine were measured consecutively for three postnatal days (24, 48, and 72 hours postnatal). Serum Ca, Mg, P, creatinine, and spot urine Ca, Mg, P, and creatinine levels were measured with a Cobas 8000 (Cobas c702) device using a Roche kit; the colorimetric method was used for serum and spot urine Ca and Mg, and the photometric ultraviolet method was used for spot urine and serum P. This study excluded infants with a birth weight below 2000 g, a gestational age below 36 weeks, a congenital metabolic disease, a family history of energy deficiency or other diseases, early encephalopathy, widespread parenchymal cranial hemorrhage or life-threatening coagulopathy, chorioamnionitis, trisomy 13, trisomy 18, or multiple organ anomalies. Ethical approval was obtained from the local ethics committee. Informed consent was obtained from a parent and/or legal guardian. Statistical Analysis The data obtained from the study were input and analyzed using the SPSS 22.0 statistics program. Descriptive values of the data obtained in the evaluation and analysis were recorded as frequency (number and percent), mean, and standard deviation (SD), depending on the type of data. The Shapiro–Wilk test was used to determine whether the data had a normal distribution. Normally distributed data were compared using the t test. The Mann–Whitney U test was used for intergroup comparisons of data that were not normally distributed. The chi-square test was used in the analysis of categorical variables. Statistical significance was set at p < 0.05. Results The demographics of the patient and control groups were similar (Table 1 ). As expected, APGAR scores were low in the HIE group (p < 0.05). The HIE group and the control group had similar delivery types. In the HIE group, 10 patients (26.3%) had convulsions, 4 (10.5%) patients died during follow-up. Serum Ca levels over the course of 3 days were found to be lower in the HIE group than in the control group, the difference being statistically significant (Table 2 , Fig. 1, p < 0.05). A total of 14 (36.8%) patients in the HIE group received intravenous Ca support. In all of these patients, the adjusted ionized Ca values was found to be below 4 mg dL. The median for 4 patients in the first 24 hours was 29.5 (18–36) mg/kg, the mean for 7 patients within 24–48 hours was 35.42 ± 6.99 mg/kg, and the median value for 10 patients within 48–72 hours was 36 (18–52) mg/kg and elementary Ca support was given. In the evaluation of Ca excretion with urine, it was observed that Ca excretion at the 24th hour was higher in the HIE group (p 0.05). Table 1 Demographic characteristics of HIE and control groups HIE group (n = 38) Control Group (n = 21) p values Birth Weight (gr) 3241,32 ± 485,88 3231,43 ± 375,75 0,93 Height (cm) 51(45–54) 50 (46–52) 0,053 Head Circumference (cm) 35,5 (33–38) 35 (33–37) 0,10 Pregnancy Week by Last Menstrual Date 39 (36–42) 39 (36–41) 0,94 Pregnancy Week According to USG 39 (34–41) 39 (36–40) 0,50 APGAR Score (1st minute) 3 (0–5) 8 (7–9) 0,001 APGAR Score (5th minute) 5 (1–6) 9 (9–10) 0,001 pH (First blood gas) 6.96 ± 0.13 - - BE (First blood gas) -18.44 ± 4.05 - - Cesarean Normal Spontaneous Vaginal Delivery 24 (%63.2) 14 (%36.8) 13 (%61.9) 8 (%38.1) - Maternal-Fetal Pathology • Placental Abruption • Gestational Diabetes • Preeclampsia • No Pathology 5 (%13.2) 1 (%2.6) 1 (%2.6) 31 (%81.6) - - Convulsion 10 (%26.3) - - Exitus 4 (%10.5) - - BE: Base Excess, HİE: Hypoxic ischemic encephalopathy Table 2 Serum electrolytes and urinary excretion of these electrolytes at the 24th, 48th and 72nd hours of the groups 24th hour 48th hour 72nd hour HIE Group (n = 38) Control Group (n = 21) P values HIE Group (n = 38) Control Group (n = 21) P values HIE Group (n = 38) Control Group (n = 21) P values Serum Ca (mg/dl) 8.57 ± 0.65 9.41 ± 0.59 0.001 8.30 ± 0.83 9.23 ± 0.28 0.001 8.42 ± 0.92 9.68 ± 0.58 0.001 Serum P (mg/dl) 5.76(2.61–8.87) 5.52(3.95–8.42) 0.40 6.48 ± 1.58 5.1 ± 0.51 0.001 6.56 ± 1.54 5.12 ± 0.76 0.001 Serum Mg (mg/dl) 1.73(0.93–2.16) 1.79(1.63–2.10) 0.18 1.76(1.36–4.45) 1.77(1.61–1.94) 0.81 1.84(1.45–2.83) 1.86(1.65–2.01) 0.60 Urine FeCa 0.95(0.12–26.66) 0.58(0.04–1.09) 0.001 0.59(0.06–28.41) 0.61 (0.11–1.01) 0.64 0.74(0.03–18.40) 0.61 (0.08–1.03) 0.22 Urine FeP 2.15(0.26–20.09) 3.14(0.11–8.41) 0.70 9.61(0.28–37.24) 3.06(0.92–11.59) 0.02 13.70(0.24–46.62) 2.54(0.49–7.21) 0.001 Urine FeMg 0.67(0.05–5.54) 0.41(0-1.23) 0.03 0.76(0.01–10.06) 0.42(0.09–0.96) 0.06 0.73 (0.08–17.12) 0.49 (0.04–1.12) 0.08 HIE: Hypoxic ischemic encephalopathy, Ca: Calcium, P: Phosphorus, Mg: Magnesium, Fe: Fraction When the serum P levels were examined, it was observed that while there was no difference between the P levels at the 24th hour between the HIE and the control group (p > 0.05), the serum P levels measured at the 48th and 72nd hours were higher in the HIE group (Table 2 , Fig. 2, p < 0.05). However, parallel to the increase in serum P levels, urinary FeP excretion was found to be higher in the HIE group at the 48th and 72nd hours (Table 2 , Fig. 2, p 0.05). However, hypomagnesemia (< 1.6 mg/dL Mg) was observed in 5 patients (13%) in the HIE group and these patients received intravenous Mg supplementation. FeMg excretion at 24, 48, and 72 hours was found to be higher in the HIE group compared to the control group, but only the value measured at 24 hours was statistically significant (Table 2 , Fig. 3). Discussion The aim of this study is to evaluate the effect of renal tubular involvement on serum electrolytes in infants with HIE. We have shown that serum Ca, P, and Mg values can be affected by urine excretion. There may be many other factors (e.g., renal effect of hypoxia, effects of hypothermia, hormonal effects) that can cause this phenomenon. However, we have shown that increased urinary excretion of these substances is a causative factor. Previous studies have shown that hypocalcemia is a common problem in newborns with HIE [9]. However, previous studies of TH use in newborns with HIE did not report any difference in the incidence of hypocalcemia between chilled babies and controls. In other words, it has been shown that TH does not increase the risk of hypocalcemia [10,11]. Saha et al. [12] found the rate of hypocalcemia in babies with PA to be 23.33%. In Yamamoto et al.’s study [13] evaluating 16 patients who underwent brain hypothermia, they found that serum ionized Ca (iCa) levels measured in the first 6 hours were below 0.8 mmol/L in 4 patients (25%). They found that early hypocalcemia was associated with poor neurological prognosis, with a cutoff value of < 1.05 mmol/L iCa for poor neuroprognosis. In another study in which 89 patients who underwent TH due to HIE were evaluated, 11 (12%) of the patients developed hypocalcemia [14]. Odo et al. [15] evaluated serum iCa in newborns with PA and showed that the iCa value in the PA group was lower than the healthy control group. Similar to results in the prior literature, hypocalcemia was observed in 14 (36.8%) of the patients in the HIE group in our study. Calcium support was given to 4 patients in the first 24 hours, 7 patients within 24–48 hours, and 10 patients within 48–72 hours. Hypocalcemia was not observed in any of the babies in the control group. Serum Ca values measured at 24, 48, and 72 hours were found to be statistically significantly lower in the HIE group than in the control group. Urine Ca excretion at 24 and 72 hours was higher in the HIE group than the control group, which was statistically significant at the 24th hour. There have been no prior studies in the literature on urinary FeCa values in patients receiving TH treatment for HIE. Normal newborns have increased serum P levels in the first 3 days of life due to decreased renal glomerular filtration, insufficient parathyroid hormone (PTH) secretion, and less tubular effects of PTH. Serum P levels decrease over time and these effects disappear at other stages of life [16]. In PA, serum P levels increase due to the release of intracellular P into the extracellular environment and decreased glomerular filtration [17]. Similar to results in the literature, serum P levels measured at 48 and 72 hours were found to be significantly higher in babies with HIE compared to the control group. However, serum P levels measured at the 24th hour were similar to the control group. Polderman et al. studied applied hypothermia treatment in adult patients who had severe head trauma and found that serum P levels of these patients decreased and urinary P levels increased. They concluded that increased urinary excretion of phosphorus decreased serum phosphorus levels [18], similarly to this study, in which we found increased urinary P levels at 48 and 72 hours in babies who underwent TH. It has been reported in previous studies that patients with PA may develop hypomagnesemia. Saha et al. [12] found the rate of hypomagnesemia in babies with PA to be 10%. Tocco et al. showed that 80% of infants with whole body cooling had magnesium levels below 1.6 mg/dL [19]. Similar to this study, the rate of hypomagnesemia (< 1.6 mg/dL) was found to be 13% in our HIE group. Hypomagnesemia (< 1.6 mg/dL) was not observed in the control group. Urine FeMg excretion at 24, 48, and 72 hours was higher in the HIE group. However, only the 24-hour urinary magnesium excretion was statistically significantly higher. Conclusions We have shown that the serum Ca, P, and Mg levels of newborns who receive TH treatment for HIE are affected by urinary excretion of these substances. However, studies with more patients are needed to confirm this result. Abbreviations PA: perinatal asphyxia; HIE: hypoxic-ischemic encephalopathy; TH: Therapeutic hypothermia; PTH: parathyroid hormone Declarations Acknowledgements Research team members and all the mothers who consented to the study. Authors’ contributions OB, Bİ, FB, ÇK and AÖ conceptualized the study. OB and Bİ conducted the first draft of the analysis. OB and AÖ reviewed the statistical analysis. OB and Bİ made the first draft. OB, Bİ, BÇ and AÖ reviewed and revised the manuscript. All authors read and approved the final version of the manuscript. Funding No funding from any institution. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate Ethical approval was obtained from the local ethics committee (Erciyes Medical Faculty). Written consent was obtained from the participants enrolled in the study. Consent for publication Not applicable. Competing interests None. Author details 1 Health Sciences University, Kayseri City Hospital, Neonatal Unit, Kayseri, Turkey 2 Health Sciences University, Kayseri City Hospital, Department of Pediatrics, Kayseri, Turkey 3 Health Sciences University, Kayseri City Hospital, Department of Pediatric Nephrology, Kayseri, Turkey 4 Health Sciences University, Kayseri City Hospital, Department of Biochemistry, Kayseri, Turkey References Levition A, Nelson KB. Perslans with definition and classification of newborn encephalopathy. Pediatr Neurol 1992;8:88–95. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013;1:CD003311. Türk Neonatoloji Derneği Hipoksik İskemik Ensefalopati Çalışma Grubu. Türkiye’de yenidoğan yoğun bakım ünitelerinde izlenen hipoksik iskemik ensefalopatili olgular, risk faktörleri, insidans ve kısa dönem prognozları. Çocuk Sağlığı ve Hastalıkları Dergisi 2008;51:123-9. Zhou KQ, Davidson JO, Bennet L, Gunn AJ. Combination treatments with therapeutic hypothermia for hypoxic-ischemic neuroprotection. Dev Med Child Neurol 2020;62(10):1131-7. Medani SA, Kheir AE, Mohamed MB. Acute kidney injury in asphyxiated neonates admitted to a tertiary neonatal unit in Sudan. Sudan J Paediatr 2014;14(2):29-34. Tsang RC, Chen I, Hayes W, Atkinson W, Atherton H, Edwards N. Neonatal hypocalcemia in infants with birth asphyxia. J Pediatr 1974;84(3):428-33. Geven WB, Monnens LA, Willems JL. Magnesium metabolism in childhood. Miner Electrolyte Metab 1993;19(4-5):308-13. Haycock GB. Management of acute and chronic renal failure in the newborn. Semin Neonatol 2003;8(4):325-34. Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr 2010;77(10):1123-8. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005;365(9460):663-70. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005;353(15):1574–84. Saha D, Ali MA, Haque MA, Ahmed MS, Sutradhar PK, Latif T, et al. Association of hypoglycemia, hypocalcemia and hypomagnesemia in neonates with perinatal asphyxia. Mymensingh Med J 2015;24(2):244-50. Yamamoto Y, Ibara S, Tokuhisa T, Hirakawa E, Yoneda S, Kobayashi K, et al. Calcium concentration in hypoxic-ischemic encephalopathy during hypothermia. Pediatr Int 2015;57(1):64-7. Vayalthrikkovil S, Bashir R, Espinoza M, Irvine L, Scott JN, Mohammad K. Serum calcium derangements in neonates with moderate to severe hypoxic ischemic encephalopathy and the impact of therapeutic hypothermia: a cohort study. J Matern Fetal Neonatal Med 2020;33(6):935-40. Odo KE, Odetunde OI, Chinawa JM, Okafor HU, Aronu AE, Adimora GN. Comparison of plasma electrolytes of perinatally asphyxiated and normal term babies. J Neonatal Perinatal Med 2019;12(4):385-9. Connelly JP, Crawford JD, Watson J. Studies of neonatal hyperphosphatemia. Pediatrics 1962;30:425-32. Otto Buczkowska E. Homeostaza gospodarki fosforanowo-wapniowej w populacji rozwojowej. Cześć II: Zaburzenia gospodarki fosforanowo-wapniowej w okresie noworodkowym [Calcium and phosphorus homeostasis in the developmental population. Part II: neonatal disturbances in the serum calcium and phosphorus concentration]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2002;8(2):105-10. Polderman KH, Peerdeman SM, Girbes AR. Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001;94(5):697-705. Tocco NM, Hodge AE, Jones AA, Wispe JR, Valentine CJ. Neonatal therapeutic hypothermia-associated hypomagnesemia during parenteral nutrition therapy. Nutr Clin Pract 2014;29(2):246-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-244271","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":12737918,"identity":"04f1b688-9073-4edf-ba86-117eb48a77e0","order_by":0,"name":"Osman Baştuğ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYDCCAxCqvp+9B8zg4SNWC+PMnjNgDg8b0Vo2zMiBcAhq4bt9+PCnGzV3mA0k3x58/DHHToaNgfnhoxt4tEieS0uTzjn2jM1cOi/Z4OC2ZKDD2IyNc/BoMTjDY8acw3aYx3J2jpnEwW3MQC08bNIEtBh/zvl3WMLg5hmQlnqitBhI57YdNjC4wQPScpiwFskzbGnSuX2HEyR7cowNzm47zsPGTMAvfGeYD3/O+XY4gZ/9jOGDym3V9vzszQ8f49OCBTCTpnwUjIJRMApGARYAADpxSOj6RW67AAAAAElFTkSuQmCC","orcid":"","institution":"Health Sciences University, Kayseri City Hospital, Neonatal Unit","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Osman","middleName":"","lastName":"Baştuğ","suffix":""},{"id":12737919,"identity":"0abc09f7-1837-462e-9f64-054ad32b4060","order_by":1,"name":"Bahadır İnan","email":"","orcid":"","institution":"Health Sciences University, Kayseri City Hospital, Department of Pediatrics","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bahadır","middleName":"","lastName":"İnan","suffix":""},{"id":12737920,"identity":"ac6e9a74-0672-441b-adad-36f26aa4af0e","order_by":2,"name":"Ahmet Özdemir","email":"","orcid":"","institution":"Health Sciences University, Kayseri City Hospital, Neonatal Unit","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"","lastName":"Özdemir","suffix":""},{"id":12737921,"identity":"913c2fc7-1ce8-4bd5-b37b-845ddf8ccf29","order_by":3,"name":"Binnaz Çelik","email":"","orcid":"","institution":"Health Sciences University, Kayseri City Hospital, Department of Pediatrics","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Binnaz","middleName":"","lastName":"Çelik","suffix":""},{"id":12737922,"identity":"4517d9ec-4255-4095-9788-887e43be60a3","order_by":4,"name":"Funda Baştuğ","email":"","orcid":"","institution":"Health Sciences University, Kayseri City Hospital, Department of Pediatric Nephrology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Funda","middleName":"","lastName":"Baştuğ","suffix":""},{"id":12737923,"identity":"fb3911b9-5a4e-47ce-82a7-6a2e444da878","order_by":5,"name":"Çiğdem Karakükcü","email":"","orcid":"","institution":"Health Sciences University, Kayseri City Hospital, Department of Biochemistry","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Çiğdem","middleName":"","lastName":"Karakükcü","suffix":""}],"badges":[],"createdAt":"2021-02-15 18:59:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-244271/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-244271/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":6411233,"identity":"2e3ffa40-40d8-49c3-86ec-1ced27ffc695","added_by":"auto","created_at":"2021-02-26 21:43:33","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2871113,"visible":true,"origin":"","legend":"(caption included in figure)","description":"","filename":"Figure1Ca.jpg","url":"https://assets-eu.researchsquare.com/files/rs-244271/v1/2301c732809fa4827f7a69e1.jpg"},{"id":6411026,"identity":"0872a7de-13ac-4fd7-951b-b67e1b395702","added_by":"auto","created_at":"2021-02-26 21:40:33","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2815043,"visible":true,"origin":"","legend":"(caption included in figure)","description":"","filename":"Figure2P.jpg","url":"https://assets-eu.researchsquare.com/files/rs-244271/v1/55ee9f36eb97af727a0d088a.jpg"},{"id":6411231,"identity":"95b8b348-a25f-4d29-9fba-4fd1b3f00176","added_by":"auto","created_at":"2021-02-26 21:43:33","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2162955,"visible":true,"origin":"","legend":"(caption included in figure)","description":"","filename":"Figure3Mg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-244271/v1/b1745e8e254b4d546465e7c6.jpg"},{"id":6411232,"identity":"6fd1c6b0-5881-43cd-8914-edf2c8e0c042","added_by":"auto","created_at":"2021-02-26 21:43:33","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2871113,"visible":true,"origin":"","legend":"(caption included in figure)","description":"","filename":"Figure1Ca.jpg","url":"https://assets-eu.researchsquare.com/files/rs-244271/v1/262055e20ae70e52d81e42c0.jpg"},{"id":13673128,"identity":"454583d1-43c5-4417-a7ef-b2c38df9c44a","added_by":"auto","created_at":"2021-09-17 11:15:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":694065,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-244271/v1/4028c357-ce49-422f-a62b-20a0d2860c0d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of the Excretion of Calcium, Magnesium, and Phosphate on the Serum Levels of These Substances in Newborns Who Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite advancing technology and treatments, perinatal asphyxia (PA) and one of its consequences, hypoxic-ischemic encephalopathy (HIE), continue to be significant health problems in neonatal patients. Moderate and severe HIE is seen in 1 to 3 out of every 1000 live births in developed countries [1,2], and its frequency in Turkey is 2.6 out of every 1000 live births [3]. Therapeutic hypothermia (TH) is a treatment method proven to reduce mortality and morbidity in full-term and near-term babies with moderate and severe HIE [4].\u003c/p\u003e\n\u003cp\u003ePA is known to cause acute kidney injury [5], and studies have also shown that PA can cause hypocalcemia, hypomagnesemia, and hyperphosphatemia [6\u0026ndash;8]. This suggests that the urinary excretion of these substances can affect the serum calcium (Ca), magnesium (Mg), and phosphorus (P) levels of infants that have undergone TH due to HIE. It is possible that tubular dysfunction due to PA may affect the excretion and serum levels of these elements. To the best of our knowledge, this study is the first of its kind, and thus fills a gap in the literature, it will help us understand the relationship between renal involvement and serum electrolyte concentrations.\u003c/p\u003e\n\u003cp\u003eWe aimed to evaluate the effect of Ca, Mg and P tubular excretions on the development of hypocalcemia, hypomagnesemia and hyperphosphatemia in patients who underwent TH for Grade 2\u0026ndash;3 HIE.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eThis prospective study included 38 infants (HIE group) who underwent TH for the treatment of HIE between January 10 and August 10, 2019, in Kayseri City Hospital\u0026rsquo;s Neonatal Intensive Care Unit and 21 healthy newborns (control group).\u003c/p\u003e\n\u003cp\u003eThe newborns diagnosed with HIE were grouped according to modified Sarnat\u0026amp;Sarnat clinical staging criteria. As determined by clinical and laboratory data, whole-body TH treatment was applied to patients who met the diagnostic criteria for Stage 2 and 3 HIE using a TH Arctic Sun 5000 (produced by Medivance, Inc. of Louisville, Colorado) device. TH was started within the first six hours of the infant\u0026rsquo;s life. Body temperatures were monitored using a rectal probe. The infant was cooled rapidly, and their temperature was kept at 33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u0026deg;C for 72 hours. Their temperature was then raised by 0.25\u0026deg; C/hour to be between 36.5 and 37.5\u0026deg;C within 12 hours.\u003c/p\u003e\n\u003cp\u003eAlong with the prenatal, natal, and postnatal histories of the patients included in the study, serum and spot urine Ca, Mg, P, and creatinine were measured consecutively for three postnatal days (24, 48, and 72 hours postnatal). Serum Ca, Mg, P, creatinine, and spot urine Ca, Mg, P, and creatinine levels were measured with a Cobas 8000 (Cobas c702) device using a Roche kit; the colorimetric method was used for serum and spot urine Ca and Mg, and the photometric ultraviolet method was used for spot urine and serum P.\u003c/p\u003e\n\u003cp\u003eThis study excluded infants with a birth weight below 2000 g, a gestational age below 36 weeks, a congenital metabolic disease, a family history of energy deficiency or other diseases, early encephalopathy, widespread parenchymal cranial hemorrhage or life-threatening coagulopathy, chorioamnionitis, trisomy 13, trisomy 18, or multiple organ anomalies.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the local ethics committee.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from a parent and/or legal guardian.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data obtained from the study were input and analyzed using the SPSS 22.0 statistics program. Descriptive values of the data obtained in the evaluation and analysis were recorded as frequency (number and percent), mean, and standard deviation (SD), depending on the type of data. The Shapiro\u0026ndash;Wilk test was used to determine whether the data had a normal distribution. Normally distributed data were compared using the t test. The Mann\u0026ndash;Whitney U test was used for intergroup comparisons of data that were not normally distributed. The chi-square test was used in the analysis of categorical variables. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographics of the patient and control groups were similar (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). As expected, APGAR scores were low in the HIE group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The HIE group and the control group had similar delivery types. In the HIE group, 10 patients (26.3%) had convulsions, 4 (10.5%) patients died during follow-up. Serum Ca levels over the course of 3 days were found to be lower in the HIE group than in the control group, the difference being statistically significant (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A total of 14 (36.8%) patients in the HIE group received intravenous Ca support. In all of these patients, the adjusted ionized Ca values was found to be below 4 mg dL. The median for 4 patients in the first 24 hours was 29.5 (18\u0026ndash;36) mg/kg, the mean for 7 patients within 24\u0026ndash;48 hours was 35.42\u0026thinsp;\u0026plusmn;\u0026thinsp;6.99 mg/kg, and the median value for 10 patients within 48\u0026ndash;72 hours was 36 (18\u0026ndash;52) mg/kg and elementary Ca support was given. In the evaluation of Ca excretion with urine, it was observed that Ca excretion at the 24th hour was higher in the HIE group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but the excretion values measured at other hours were similar to the control and HIE groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;1, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic characteristics of HIE and control groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHIE group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eControl Group\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep values\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBirth Weight (gr)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3241,32\u0026thinsp;\u0026plusmn;\u0026thinsp;485,88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3231,43\u0026thinsp;\u0026plusmn;\u0026thinsp;375,75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,93\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHeight (cm)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51(45\u0026ndash;54)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50 (46\u0026ndash;52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,053\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHead Circumference (cm)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35,5 (33\u0026ndash;38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (33\u0026ndash;37)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePregnancy Week by Last Menstrual Date\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (36\u0026ndash;42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (36\u0026ndash;41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,94\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePregnancy Week According to USG\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (34\u0026ndash;41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39 (36\u0026ndash;40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAPGAR Score (1st minute)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (0\u0026ndash;5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (7\u0026ndash;9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAPGAR Score (5th minute)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1\u0026ndash;6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (9\u0026ndash;10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003epH (First blood gas)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBE (First blood gas)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-18.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCesarean\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNormal Spontaneous Vaginal Delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (%63.2)\u003c/p\u003e\n\u003cp\u003e14 (%36.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (%61.9)\u003c/p\u003e\n\u003cp\u003e8 (%38.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal-Fetal Pathology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003ePlacental Abruption\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eGestational Diabetes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003ePreeclampsia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eNo Pathology\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (%13.2)\u003c/p\u003e\n\u003cp\u003e1 (%2.6)\u003c/p\u003e\n\u003cp\u003e1 (%2.6)\u003c/p\u003e\n\u003cp\u003e31 (%81.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eConvulsion\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (%26.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eExitus\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (%10.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eBE: Base Excess, HİE: Hypoxic ischemic encephalopathy\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSerum electrolytes and urinary excretion of these electrolytes at the 24th, 48th and 72nd hours of the groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e24th hour\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e48th hour\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e72nd hour\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHIE Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003evalues\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHIE Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003evalues\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHIE Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eControl Group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003evalues\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSerum Ca (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSerum P (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.76(2.61\u0026ndash;8.87)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.52(3.95\u0026ndash;8.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSerum Mg (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.73(0.93\u0026ndash;2.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.79(1.63\u0026ndash;2.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.76(1.36\u0026ndash;4.45)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.77(1.61\u0026ndash;1.94)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.84(1.45\u0026ndash;2.83)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.86(1.65\u0026ndash;2.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.60\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUrine FeCa\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.95(0.12\u0026ndash;26.66)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.58(0.04\u0026ndash;1.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.59(0.06\u0026ndash;28.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.61 (0.11\u0026ndash;1.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.74(0.03\u0026ndash;18.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.61 (0.08\u0026ndash;1.03)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUrine FeP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.15(0.26\u0026ndash;20.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.14(0.11\u0026ndash;8.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.61(0.28\u0026ndash;37.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.06(0.92\u0026ndash;11.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.70(0.24\u0026ndash;46.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.54(0.49\u0026ndash;7.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUrine FeMg\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.67(0.05\u0026ndash;5.54)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.41(0-1.23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.76(0.01\u0026ndash;10.06)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.42(0.09\u0026ndash;0.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.73 (0.08\u0026ndash;17.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.49 (0.04\u0026ndash;1.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"10\"\u003eHIE: Hypoxic ischemic encephalopathy, Ca: Calcium, P: Phosphorus, Mg: Magnesium, Fe: Fraction\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eWhen the serum P levels were examined, it was observed that while there was no difference between the P levels at the 24th hour between the HIE and the control group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), the serum P levels measured at the 48th and 72nd hours were higher in the HIE group (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, parallel to the increase in serum P levels, urinary FeP excretion was found to be higher in the HIE group at the 48th and 72nd hours (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference in serum Mg levels between the HIE group and the control group (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;3, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, hypomagnesemia (\u0026lt;\u0026thinsp;1.6 mg/dL Mg) was observed in 5 patients (13%) in the HIE group and these patients received intravenous Mg supplementation. FeMg excretion at 24, 48, and 72 hours was found to be higher in the HIE group compared to the control group, but only the value measured at 24 hours was statistically significant (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study is to evaluate the effect of renal tubular involvement on serum electrolytes in infants with HIE. We have shown that serum Ca, P, and Mg values can be affected by urine excretion. There may be many other factors (e.g., renal effect of hypoxia, effects of hypothermia, hormonal effects) that can cause this phenomenon. However, we have shown that increased urinary excretion of these substances is a causative factor.\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that hypocalcemia is a common problem in newborns with HIE [9]. However, previous studies of TH use in newborns with HIE did not report any difference in the incidence of hypocalcemia between chilled babies and controls. In other words, it has been shown that TH does not increase the risk of hypocalcemia [10,11]. Saha et al. [12] found the rate of hypocalcemia in babies with PA to be 23.33%. In Yamamoto et al.\u0026rsquo;s study [13] evaluating 16 patients who underwent brain hypothermia, they found that serum ionized Ca (iCa) levels measured in the first 6 hours were below 0.8 mmol/L in 4 patients (25%). They found that early hypocalcemia was associated with poor neurological prognosis, with a cutoff value of \u0026lt;\u0026thinsp;1.05 mmol/L iCa for poor neuroprognosis. In another study in which 89 patients who underwent TH due to HIE were evaluated, 11 (12%) of the patients developed hypocalcemia [14]. Odo et al. [15] evaluated serum iCa in newborns with PA and showed that the iCa value in the PA group was lower than the healthy control group. Similar to results in the prior literature, hypocalcemia was observed in 14 (36.8%) of the patients in the HIE group in our study. Calcium support was given to 4 patients in the first 24 hours, 7 patients within 24\u0026ndash;48 hours, and 10 patients within 48\u0026ndash;72 hours. Hypocalcemia was not observed in any of the babies in the control group. Serum Ca values measured at 24, 48, and 72 hours were found to be statistically significantly lower in the HIE group than in the control group.\u003c/p\u003e\n\u003cp\u003eUrine Ca excretion at 24 and 72 hours was higher in the HIE group than the control group, which was statistically significant at the 24th hour. There have been no prior studies in the literature on urinary FeCa values in patients receiving TH treatment for HIE.\u003c/p\u003e\n\u003cp\u003eNormal newborns have increased serum P levels in the first 3 days of life due to decreased renal glomerular filtration, insufficient parathyroid hormone (PTH) secretion, and less tubular effects of PTH. Serum P levels decrease over time and these effects disappear at other stages of life [16]. In PA, serum P levels increase due to the release of intracellular P into the extracellular environment and decreased glomerular filtration [17]. Similar to results in the literature, serum P levels measured at 48 and 72 hours were found to be significantly higher in babies with HIE compared to the control group. However, serum P levels measured at the 24th hour were similar to the control group. Polderman et al. studied applied hypothermia treatment in adult patients who had severe head trauma and found that serum P levels of these patients decreased and urinary P levels increased. They concluded that increased urinary excretion of phosphorus decreased serum phosphorus levels [18], similarly to this study, in which we found increased urinary P levels at 48 and 72 hours in babies who underwent TH.\u003c/p\u003e\n\u003cp\u003eIt has been reported in previous studies that patients with PA may develop hypomagnesemia. Saha et al. [12] found the rate of hypomagnesemia in babies with PA to be 10%. Tocco et al. showed that 80% of infants with whole body cooling had magnesium levels below 1.6 mg/dL [19]. Similar to this study, the rate of hypomagnesemia (\u0026lt;\u0026thinsp;1.6 mg/dL) was found to be 13% in our HIE group. Hypomagnesemia (\u0026lt;\u0026thinsp;1.6 mg/dL) was not observed in the control group. Urine FeMg excretion at 24, 48, and 72 hours was higher in the HIE group. However, only the 24-hour urinary magnesium excretion was statistically significantly higher.\u003c/p\u003e"},{"header":"Conclusions","content":" \u003cp\u003eWe have shown that the serum Ca, P, and Mg levels of newborns who receive TH treatment for HIE are affected by urinary excretion of these substances. However, studies with more patients are needed to confirm this result.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003ePA: perinatal asphyxia; HIE: hypoxic-ischemic encephalopathy; TH: Therapeutic hypothermia; PTH: parathyroid hormone\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch team members and all the mothers who consented to the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOB, Bİ, FB, \u0026Ccedil;K and A\u0026Ouml; conceptualized the study. OB and Bİ conducted the first draft of the analysis. OB and A\u0026Ouml; reviewed the statistical analysis. OB and Bİ made the first draft. OB, Bİ, B\u0026Ccedil; and A\u0026Ouml; reviewed and revised the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding from any institution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the local ethics committee (Erciyes Medical Faculty). Written consent was obtained from the participants enrolled in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Health Sciences University, Kayseri City Hospital, Neonatal Unit, Kayseri, Turkey\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Health Sciences University, Kayseri City Hospital, Department of Pediatrics, Kayseri, Turkey\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Health Sciences University, Kayseri City Hospital, Department of Pediatric Nephrology, Kayseri, Turkey\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e Health Sciences University, Kayseri City Hospital, Department of Biochemistry, Kayseri, Turkey\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLevition A, Nelson KB.\u0026nbsp;Perslans with definition and classification of newborn encephalopathy.\u0026nbsp;Pediatr Neurol\u0026nbsp;1992;8:88\u0026ndash;95.\u003c/li\u003e\n\u003cli\u003eJacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013;1:CD003311.\u003c/li\u003e\n\u003cli\u003eT\u0026uuml;rk Neonatoloji Derneği Hipoksik İskemik Ensefalopati \u0026Ccedil;alışma Grubu. T\u0026uuml;rkiye\u0026rsquo;de yenidoğan yoğun bakım \u0026uuml;nitelerinde izlenen hipoksik iskemik ensefalopatili olgular, risk fakt\u0026ouml;rleri, insidans ve kısa d\u0026ouml;nem prognozları. \u0026Ccedil;ocuk Sağlığı ve Hastalıkları Dergisi 2008;51:123-9.\u003c/li\u003e\n\u003cli\u003eZhou KQ, Davidson JO, Bennet L, Gunn AJ. Combination treatments with therapeutic hypothermia for hypoxic-ischemic neuroprotection. Dev Med Child Neurol 2020;62(10):1131-7.\u003c/li\u003e\n\u003cli\u003eMedani SA, Kheir AE, Mohamed MB. Acute kidney injury in asphyxiated neonates admitted to a tertiary neonatal unit in Sudan.\u0026nbsp;Sudan J Paediatr 2014;14(2):29-34.\u003c/li\u003e\n\u003cli\u003eTsang RC, Chen I, Hayes W, Atkinson W, Atherton H, Edwards N. Neonatal hypocalcemia in infants with birth asphyxia. J Pediatr 1974;84(3):428-33.\u003c/li\u003e\n\u003cli\u003eGeven WB, Monnens LA, Willems JL. Magnesium metabolism in childhood.\u0026nbsp;Miner Electrolyte Metab 1993;19(4-5):308-13.\u003c/li\u003e\n\u003cli\u003eHaycock GB. Management of acute and chronic renal failure in the newborn.\u0026nbsp;Semin Neonatol 2003;8(4):325-34.\u003c/li\u003e\n\u003cli\u003eJain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn.\u0026nbsp;Indian J Pediatr 2010;77(10):1123-8.\u003c/li\u003e\n\u003cli\u003eGluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005;365(9460):663-70.\u003c/li\u003e\n\u003cli\u003eShankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005;353(15):1574\u0026ndash;84.\u003c/li\u003e\n\u003cli\u003eSaha D, Ali MA, Haque MA, Ahmed MS, Sutradhar PK, Latif T, et al. Association of hypoglycemia, hypocalcemia and hypomagnesemia in neonates with perinatal asphyxia. Mymensingh Med J 2015;24(2):244-50.\u003c/li\u003e\n\u003cli\u003eYamamoto Y, Ibara S, Tokuhisa T, Hirakawa E, Yoneda S, Kobayashi K, et al. Calcium concentration in hypoxic-ischemic encephalopathy during hypothermia. Pediatr Int 2015;57(1):64-7.\u003c/li\u003e\n\u003cli\u003eVayalthrikkovil S, Bashir R, Espinoza M, Irvine L, Scott JN, Mohammad K. Serum calcium derangements in neonates with moderate to severe hypoxic ischemic encephalopathy and the impact of therapeutic hypothermia: a cohort study. J Matern Fetal Neonatal Med 2020;33(6):935-40.\u003c/li\u003e\n\u003cli\u003eOdo KE, Odetunde OI, Chinawa JM, Okafor HU, Aronu AE, Adimora GN. Comparison of plasma electrolytes of perinatally asphyxiated and normal term babies. J Neonatal Perinatal Med 2019;12(4):385-9.\u003c/li\u003e\n\u003cli\u003eConnelly JP, Crawford JD, Watson J. Studies of neonatal hyperphosphatemia. Pediatrics 1962;30:425-32.\u003c/li\u003e\n\u003cli\u003eOtto Buczkowska E. Homeostaza gospodarki fosforanowo-wapniowej w populacji rozwojowej. Cześć II: Zaburzenia gospodarki fosforanowo-wapniowej w okresie noworodkowym [Calcium and phosphorus homeostasis in the developmental population. Part II: neonatal disturbances in the serum calcium and phosphorus concentration]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2002;8(2):105-10.\u003c/li\u003e\n\u003cli\u003ePolderman KH, Peerdeman SM, Girbes AR. Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 2001;94(5):697-705.\u003c/li\u003e\n\u003cli\u003eTocco NM, Hodge AE, Jones AA, Wispe JR, Valentine CJ. Neonatal therapeutic hypothermia-associated hypomagnesemia during parenteral nutrition therapy. Nutr Clin Pract 2014;29(2):246-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypoxic Ischemic Encephalopathy, Therapeutic Hypothermia, Neonatal, Calcium, Phosphorus, Magnesium","lastPublishedDoi":"10.21203/rs.3.rs-244271/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-244271/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Hypocalcemia, hypomagnesemia, and hyperphosphatemia are common electrolyte disturbances in perinatal asphyxia(PA). Different reasons have been proposed for these electrolyte disturbances. This study investigated the effect of the urinary excretion of calcium(Ca), magnesium(Mg), and phosphorus(P) on the serum levels of these substances in babies who were treated using therapeutic hypothermia for hypoxic ischemic encephalopathy(HİE) caused by PA. This study sheds light on the pathophysiology that may cause changes in the serum values of these electrolytes.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e This study included 21 healthy newborns(control group) and 38 patients(HİE group) who had undergone therapeutic hypothermia due to HİE. Only infants with a gestational age of 36 weeks and above and a birth weight of 2000 g and above were evaluated. The urine and serum Ca, Mg, P, and creatinine levels of all infants were evaluated at 24, 48, and 72 hours.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The lower serum Ca value and the higher serum P value of the HİE group were found to be statistically significant compared to the control group. There was no significant difference in serum Mg values between the groups. However, hypomagnesemia was detected in five patients from the HİE group. The urine excretions of these substances, which were checked at different times, were found to be significantly higher in the HİE group compared to the control group.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study determined that the urinary excretion of Ca, Mg, and P has an effect on the serum Ca, Mg, and P levels of infants with HİE.\u003c/p\u003e","manuscriptTitle":"The Effect of the Excretion of Calcium, Magnesium, and Phosphate on the Serum Levels of These Substances in Newborns Who Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-02-26 21:40:30","doi":"10.21203/rs.3.rs-244271/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"576c8e21-9e96-4c23-bef7-c13d718eef9a","owner":[],"postedDate":"February 26th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":2657579,"name":"Pediatrics"}],"tags":[],"updatedAt":"2021-03-01T08:44:11+00:00","versionOfRecord":[],"versionCreatedAt":"2021-02-26 21:40:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-244271","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-244271","identity":"rs-244271","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}