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Blood biomarkers for neonatal hypoxic–ischemic encephalopathy in the presence and absence of sentinel events

Journal of Perinatology volume 41, pages 1322–1330 (2021)Cite this article

Subjects

Abstract

Objective

To determine if neonatal serum biomarkers representing different pathways of injury differ for cases of HIE of unknown cause to gain insight into timing and mechanism of injury.

Study design

In this cohort of all neonates with HIE admitted to our NICU, newborns with sentinel events were compared to those without during the 1st 3 days of life. Discard neonatal blood during the 1st 3 days of life was used for analysis.

Results

Of 277 babies with HIE treated with whole-body hypothermia, 190 (68.6%) had blood available for biomarker analysis. In total, 71 (37.4%) were born within our system, and 119 (62.6%) were transferred in from outside hospitals. Of these babies, 77 (40.5%) had a sentinel event and 113 (59.6%) had no sentinel event. Although the degree of metabolic acidosis was similar, repeated measures analysis showed that during the initial 3 days of life neonates born with HIE in the absence of sentinel events had 41.4% decreased VEGF (p = 0.027) and 62.5% increased IL-10 serum concentrations (p = 0.005).

Conclusion

These changes indicate that neonatal HIE in the absence of sentinel events is not related to an unrecognized acute intrapartum event and is possibly related to chronic hypoxia of lower severity or recovery from a remote event.

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Funding

Funded by NICHD R01HD086058 “Adult Biomarkers in Neonatal Brain Injury and Development”.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Eric K. Broni

  2. Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Ahizechukwu C. Eke & Ernest M. Graham

  3. Department of Medicine, Division of General Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Dhananjay Vaidya

  4. Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Dhananjay Vaidya & Xueting Tao

  5. Department of Pediatrics, Bayview campus, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Xueting Tao

  6. Department of Pediatrics, Division of Neonatology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Frances J. Northington

  7. Neuroscience Intensive Care Nursery Program, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Frances J. Northington & Ernest M. Graham

  8. Department of Pediatrics, Division of Pediatric Cardiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    Allen D. Everett

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  1. Eric K. Broni
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Correspondence to Ernest M. Graham.

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Conflict of interest

Under a license agreement between ImmunArray Ltd. and the Johns Hopkins University, the University and ADE are entitled to royalties on an invention described in this study and discussed in this publication. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies.

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Broni, E.K., Eke, A.C., Vaidya, D. et al. Blood biomarkers for neonatal hypoxic–ischemic encephalopathy in the presence and absence of sentinel events. J Perinatol 41, 1322–1330 (2021). https://doi.org/10.1038/s41372-020-00850-5

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  • DOI: https://doi.org/10.1038/s41372-020-00850-5

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