{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:58:19Z","timestamp":1792601899084,"version":"4.5.0"},"reference-count":25,"publisher":"BMJ","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Clin Pathol"],"published-print":{"date-parts":[[1982,9]]},"abstract":"<jats:p>A series of 29 newborn infants had been studied after intrapartum hypoxia defined as meconium aspiration, an Apgar score of less than or equal to 6 at 5 min or a peripheral blood pH of 7.2 or less after resuscitation. Two independent sets of techniques were used; one concerned with the critical system in hypoxic damage, the central nervous system, the other assessing the central biochemical events in hypoxia. Both sets of data were assembled, then graded separately and only then combined. In this way detailed neurological assessment has been combined with measurement of urinary excretion of the ATP metabolites, hypoxanthine and xanthine. The essential metabolic consequence of hypoxia is a reduction in the synthesis of the energy currency of cells, ATP. This is associated with an outflow of ATP metabolites from cells. The extent of neurological damage was related to the magnitude of the hypoxanthine and xanthine excretion; neither were closely related to the initial blood pH. Infants who were normal neurologically had normal oxypurine excretion. Infants with neurological abnormalities for less than 48 h had lower excretion than those who were abnormal for more than 48 h. The duration of abnormal oxypurine excretion after an acute episode of hypoxia was studied in two infants with respiratory distress and in two other infants with apnoeic attacks. Severe hypoxia was followed by abnormal oxypurine excretion for at least 40 h after an acute episode. It is justifiable to suggest that abnormalities of oxypurine excretion should indicate intrapartum hypoxia in newborn infants. This excretion should also quantify the metabolic damage.<\/jats:p>","DOI":"10.1136\/jcp.35.9.999","type":"journal-article","created":{"date-parts":[[2007,6,9]],"date-time":"2007-06-09T00:50:46Z","timestamp":1181350246000},"page":"999-1007","source":"Crossref","is-referenced-by-count":29,"title":["Intrapartum hypoxia: the association between neurological assessment of damage and abnormal excretion of ATP metabolites."],"prefix":"10.1136","volume":"35","author":[{"given":"R A","family":"Harkness","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A G","family":"Whitelaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R J","family":"Simmonds","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1982,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1136\/adc.56.4.245","article-title":"Hearing, speech and language in survivors of severe perinatal asphyxia","volume":"56","author":"D'Souza, S.W.; McCartney, E.; Nolan, M.; Taylor, I.G.","year":"1981","unstructured":"D'Souza SW, McCartney E, Nolan M, Taylor IG. Hearing, speech and language in survivors of severe perinatal asphyxia. Arch Dis Child 1981;56:245-52.","journal-title":"Arch Dis Child"},{"key":"ref_2","first-page":"129","article-title":"Diagnostic and aetiologic features of idiopathic and symptomatic growth hormone deficiency in the Netherlands","volume":"35","author":"Steendijk, R.","year":"1980","unstructured":"Steendijk R. Diagnostic and aetiologic features of idiopathic and symptomatic growth hormone deficiency in the Netherlands. Helv Paed Acta 1980;35:129-39.","journal-title":"Helv Paed Acta"},{"key":"ref_3","first-page":"35","article-title":"Infants damaged during birth","volume-title":"Recent advances in paediatrics","author":"Brown, J.K.","year":"1976","unstructured":"Brown JK. Infants damaged during birth. In: Hull D, ed. Recent advances in paediatrics. Edinburgh: Churchill-Livingstone, 1976:35-86."},{"key":"ref_4","first-page":"784","article-title":"Diagnosis and management of fetal distress","volume-title":"Mayo Clin Proc 1979; 54","author":"Hill, L.M.","unstructured":"Hill LM. Diagnosis and management of fetal distress. Mayo Clin Proc 1979;54:784-93."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1471-0528.1981.tb01001.x","article-title":"The measurement of hypoxanthine, xanthine, inosine and uridine in umbilical cord blood and fetal scalp blood samples as a measure of fetal hypoxia","volume":"88","author":"O'Connor, M.C.; Harkness, R.A.; Simmonds, R.J.; Hytten, F.E.","year":"1981","unstructured":"O'Connor MC, Harkness RA, Simmonds RJ, Hytten FE. The measurement of hypoxanthine, xanthine, inosine and uridine in umbilical cord blood and fetal scalp blood samples as a measure of fetal hypoxia. Br J Obstet Gynaecol 1981;88:381-90.","journal-title":"Br J Obstet Gynaecol"},{"key":"ref_6","first-page":"36981","article-title":"High performance liquid chromatographic methods for base and nucleoside analysis in extracellular fluids and in cells","volume":"226","author":"Simmonds, R.J.; Harkness, R.A.","year":"1981","unstructured":"Simmonds RJ, Harkness RA. High performance liquid chromatographic methods for base and nucleoside analysis in extracellular fluids and in cells. J Chromatogr 1981;226:36981.","journal-title":"J Chromatogr"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0143-4004(82)80015-5","article-title":"Nucleotide, nucleoside and purine base concentrations in human placentae","volume":"3","author":"Simmonds, R.J.; Coade, S.B.; Harkness, R.A.; Drury, L.; Hytten, F.E.","year":"1982","unstructured":"Simmonds RJ, Coade SB, Harkness RA, Drury L, Hytten FE. Nucleotide, nucleoside and purine base concentrations in human placentae. Placenta 1982;3:29-38","journal-title":"Placenta"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/j.1471-0528.1981.tb01000.x","article-title":"Raised hypoxanthine, xanthine and uridine concentrations in meconium stained amniotic fluid and during labour","volume":"88","author":"O'Connor, M.C.; Harkness, R.A.; Simmonds, R.J.; Hytten, F.E.","year":"1981","unstructured":"O'Connor MC, Harkness RA, Simmonds RJ, Hytten FE. Raised hypoxanthine, xanthine and uridine concentrations in meconium stained amniotic fluid and during labour. Br J Obstet Gynaecol 1981;88:375-80.","journal-title":"Br J Obstet Gynaecol"},{"key":"ref_9","article-title":"Urinary hypoxanthine, xanthine and uric acid excretion in newborn infants with perinatal complications. Acta Paed Scand 1977; 66: 713-7. \" Dubowitz L, Dubowitz V. Neurological assessment of the preterm and full term newborn. Clinics in development medicine 79","author":"Manzke, H.; Dorner, K.; Grunitz, J.","year":"1981","unstructured":"\u00b0 Manzke H, Dorner K, Grunitz J. Urinary hypoxanthine, xanthine and uric acid excretion in newborn infants with perinatal complications. Acta Paed Scand 1977;66:713-7. \" Dubowitz L, Dubowitz V. Neurological assessment of the preterm and full term newborn. Clinics in development medicine 79. London: Spastics International Medical Publications, 1981."},{"key":"ref_10","article-title":"Neck extensor hypertonia: a clinical sign of insult to the central nervous system of the newborn. Early Hum Dev 1977; 1\/2: 181-90. '3 Harkness RA, Simmonds RJ, Edwards AC, Valman HB, Dore CJ. Hypoxanthine and xanthine excretion by normal newborn infants","author":"Amiel-Tyson, C.; Korobkin, R.; Esquevaucouloux, M.","unstructured":"Amiel-Tyson C, Korobkin R, Esquevaucouloux M. Neck extensor hypertonia: a clinical sign of insult to the central nervous system of the newborn. Early Hum Dev 1977;1\/2:181-90. '3 Harkness RA, Simmonds RJ, Edwards AC, Valman HB, Dore CJ. Hypoxanthine and xanthine excretion by normal newborn infants. Submitted for publication."},{"key":"ref_11","first-page":"625","article-title":"Cellular energy metabolism and its regulation","volume":"5","author":"Atkinson, D.E.","year":"1977","unstructured":"Atkinson DE. Cellular energy metabolism and its regulation. London: Academic Press, 1977. '5 Sutton JR, Toews CJ, Ward GR, Fox IH. Purine metabolism during strenuous muscular exercise in man. Metabolism 1980;29:254-60. '6 Raivio KO. Neonatal hyperuricaemia. J Pediatr 1976;88:625-30.","journal-title":"J Pediatr; Purine metabolism during strenuous muscular exercise in man. Metabolism 1980; 29: 254-60. '6 Raivio KO. Neonatal hyperuricaemia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1159\/000241328","article-title":"Urinary loss of oxypurines in hypoxic premature neonates","volume":"38","author":"Jensen, M.H.; Brinklov, M.M.; Lillqvist, K.","year":"1980","unstructured":"Jensen MH, Brinklov MM, Lillqvist K. Urinary loss of oxypurines in hypoxic premature neonates. Biol Neonate 1980;38:40-8.","journal-title":"Biol Neonate"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1152\/jappl.1964.19.2.246","article-title":"Nature of purines excreted during muscular exercise","volume":"19","author":"Nasrallah, S.; Al-Khalidi, U.","year":"1964","unstructured":"Nasrallah S, Al-Khalidi U. Nature of purines excreted during muscular exercise. 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J Pediatr 1976;88:856-8.","journal-title":"J Pediatr"},{"key":"ref_16","first-page":"867","article-title":"Delayed micturition in the newborn period","volume":"80","author":"Moore, E.S.; Galvez, M.B.","year":"1972","unstructured":"Moore ES, Galvez MB. Delayed micturition in the newborn period. J Pediatr 1972;80:867-73.","journal-title":"J Pediatr"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/0002-9378(75)90052-6","article-title":"Significance of meconium during labour","volume":"122","author":"Miller, F.C.; Sacks, D.A.; Yeh, S.-Y.","year":"1975","unstructured":"Miller FC, Sacks DA, Yeh S-Y, et al. Significance of meconium during labour. Am J Obstet Gynecol 1975;122:573-80.","journal-title":"Am J Obstet Gynecol"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/0002-9343(64)90128-7","article-title":"Clinical, physiological and biochemical studies of a patient with xanthinuria and phenochromocytoma","volume":"37","author":"Engelman, K.; Watts, R.W.E.; Klinenberg, JR, Sjoerdsma; A, Seegmiller; J.E.","year":"1964","unstructured":"Engelman K, Watts RWE, Klinenberg JR, Sjoerdsma A, Seegmiller JE. Clinical, physiological and biochemical studies of a patient with xanthinuria and phenochromocytoma. Am J Med 1964;37:839-61.","journal-title":"Am J Med"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1139\/o81-017","article-title":"Recovery of nucleotide levels after cell injury","volume":"59","author":"Warnick, C.T.; Lazarus, H.M.","year":"1981","unstructured":"Warnick CT, Lazarus HM. Recovery of nucleotide levels after cell injury. Can J Biochem 1981;59:116-21.","journal-title":"Can J Biochem"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3109\/00365517609055244","article-title":"Oxypurine excretion during kidney preservation: an indicator of ischaemic damage","volume":"36","author":"Buhl, M.R.","year":"1976","unstructured":"Buhl MR. Oxypurine excretion during kidney preservation: an indicator of ischaemic damage. Scand J Clin Lab Invest 1976;36: 169-74.","journal-title":"Scand J Clin Lab Invest"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1093\/oxfordjournals.jbchem.a131852","article-title":"Energy transduction and adenine nucleotides in mitochondria from rat liver after hypoxic perfusion","volume":"82","author":"Nakazawa, T.; Nunokawa, T.","year":"1977","unstructured":"Nakazawa T, Nunokawa T. Energy transduction and adenine nucleotides in mitochondria from rat liver after hypoxic perfusion. J Biochem 1977;82:1575-83.","journal-title":"J Biochem"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1432-0436.1979.tb00985.x","article-title":"The increasing adenine nucleotide concentration and the maturation of rat liver mitochondria during development","volume":"12","author":"Sutton, R.; Pollak, J.K.","year":"1978","unstructured":"Sutton R, Pollak JK. The increasing adenine nucleotide concentration and the maturation of rat liver mitochondria during development. Differentiation 1978; 12:15-21.","journal-title":"Differentiation"},{"key":"ref_23","first-page":"235","article-title":"Thyroid thermogenesis and active sodium transport","volume":"30","author":"Edelman, I.S.; Ismail Beigi, F.","year":"1974","unstructured":"Edelman IS, Ismail Beigi F. Thyroid thermogenesis and active sodium transport. Recent Prog Horm Res 1974;30:235-57.","journal-title":"Recent Prog Horm Res"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"382414","DOI":"10.1152\/physrev.1972.52.2.382","article-title":"Ammonia production in muscle and other tissues: the purine nucleotide cycle","volume":"52","author":"Lowenstein, J.M.","year":"1972","unstructured":"Lowenstein JM. Ammonia production in muscle and other tissues: the purine nucleotide cycle. Physiol Rev 1972;52:382414.","journal-title":"Physiol Rev"},{"key":"ref_25","first-page":"705","article-title":"Cardiac failure in the dog as a consequence of exogenous hyperthyroidism. Circulation Res 1967; 20: 242-52. 3\"","volume":"96","author":"Piatnek-Leumissen, D.; Olson, R.E.","year":"1980","unstructured":"Piatnek-Leumissen D, Olson RE. Cardiac failure in the dog as a consequence of exogenous hyperthyroidism. Circulation Res 1967;20:242-52. 3\" Cabal LA, Devaskar U, Siassi B, Hodgman JE, Emmanouilides G. Cardiogenic shock associated with perinatal asphyxia in preterm infants. 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