الفهرس 
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Abstract
Perinatal asphyxia is the most important cause of morbidity and mortality in term neonates (Legido, 1994). Perinatal asphyxia is an insult to the fetus or newborn due to lack of oxygen (hypoxia) and /or lack of perfusion (ischemia) to various organs (Evan and Jhon, 1991). The incidence of perinatal asphyxia is about 1.0 - 1.5 % in most centers and is usually related to gestational age and birth weight ( Mac-Donald et al., 1980). Conditions associated with asphyxia may be maternal, fetal and neonatal in origin, although many of the maternal and fetal conditions associated with asphyxia may be identifiedprior to delivery, neonatal
conditions usually are not evident until delivery of the infant (James, 1983). Sever perinatal stress can produce profound effects on the myocardium and results in myocardial dysfunction in newborn infants (Welther et al., 1986). Creative kinase(CK) and its isoenzymes (CK-BB, CK-MB ,CK-MM) have been found elevated in umblical venous cord in response to injury from perinatal asphyxia and fetal distress. The increase of CK and its isoenzymes is supposed to occur as the result of ischemia-induced leakage of enzyme from injured tissue in which the enzym ines are located (Primhak et al., 1985). The electrocardiogram(ECG) done for infants with perinatal asphyxia who may have transient myocardial ischemia may show ST depression in the midprecordiwn and T wave inversion in the left precordiwn (Perhnan et al., 1989). Using the inununihibtion method we detect the level of cardiospecific isoenzyme CK-MB activity in the sera of 40 neonates : 25
cases having clinical manifestations of perinatal asph neonates severed as a control Yea and 15 normal group. CK-MB was done after birth (cord sera) and after 24 hours; also ECG was done at birth and after 24 h. CK-MB of cord sera of the cases was found to be elevated 5-10 folds more than the normal and its level was decreased after 24 hours but did not reach the normal reference value of the neonatas.
CK-MB of the mother’s sera was higher than the normal but less than that of the cord sera. The level of increased CK-MB was found to be not affected by the different etiological factors of perinatal asphyxia. Regarding ECG changes : among 25 cases having signs of perinatal asphyxia there were 15 cases having ECG evidence of myocardial ischemia in the form of inverted T wave and depressed ST segment. Also there were 8 cases having P puhnonale in LII.
After 24 hours there was improvement of 10 cases out of 15 cases having ECG changes and became ECG free. The increase of CK-MB level among cases having perinatal asphyxia did not depend on the presence or absence of ECG changes, so it is more predictive to myocardial ischemic in cases complaining of perinatal asphyxia more than ECG.