Abstract
Background: Hypoxic-ischemic brain injury (HIE) is the most common perinatal cerebral insult associated with adverse motor and cognitive outcome. In preterm infants, neurological signs and clinical manifestations of hypoxic brain damage are late and limited criteria for therapeutic interventions. Neonatal seizures are not disease- specific, subtle and difficult to recognize clinically. Currently, specific biochemical markers of brain injury are used to assess brain damage after HIE in neonates.
Aim: In this study, Enolase (NSE) and Protein S-100 (PS-100) serum levels were studied serially during the first week of life in a group of preterm neonates with HIE as markers of neuronal and glial damage respectively. Changes in serum levels of these brain- specific markers could be used for non- invasive diagnostic purpose during the perinatal period.
Methods: A population of 30 outborn preterm infants (GA 33. 6 +- 2.30 weeks gestation and 2150 +- 652 gr birth weight) with a diagnosis of perinatal asphyxia, admitted to the NICU of the University of Catania within the first three hours of life were studied. Depending on umbilical pH and lactic acid values (LA) they were divided in two groups: babies with severe HIE (pH 7.16 +- 00.6 and LA 6.32 +- 0.04 mmol/L) and those with moderate HIE (pH 7.26 +- 0.04 and LA 2.64 +- 0.63 mnol/L). NSE and PS-100 serum levels were measured at time 3, 24, 40 hours after birth and repeated at 7 days of life. Both groups of babies had ultrasound examination and CFM monitoring at birth and at 3 weeks of life.
Results: The results of the study are shown on table 1. Mean serum levels for both markers (NSE and PS-100) were constantly and significantly elevated in the group of babies with severe HIE (p<0.05). In these babies, NSE values decreased progressively from birth to the seventh day of life. However, PS-100 values showed a different pattern, increasing from 48 hours to 7 days of life.
Conclusions: These results suggest regional mechanisms of hypoxic brain damage in preterm babies, involving different cell populations. NSE can be considered a more specific biochemical marker of precocious and more rapid neuronal damage. PS-100, instead, could be expression of white matter damage involving for a more long time differentiating oligodendroglia. Both markers will be helpful to guide a correct application of early neuroprotective treatments.
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Betta, P., Curreri, R., Romeo, M. et al. 37 Biochemical Markers of Regional Brain Injury in Preterm Babies with Perinatal Asphyxia. Pediatr Res 58, 360 (2005). https://doi.org/10.1203/00006450-200508000-00066
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DOI: https://doi.org/10.1203/00006450-200508000-00066
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