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Perrone S, Grassi F, Caporilli C, Boscarino G, Carbone G, Petrolini C, Gambini LM, Di Peri A, Moretti S, Buonocore G, Esposito SMR. Brain Damage in Preterm and Full-Term Neonates: Serum Biomarkers for the Early Diagnosis and Intervention. Antioxidants (Basel) 2023; 12:antiox12020309. [PMID: 36829868 PMCID: PMC9952571 DOI: 10.3390/antiox12020309] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The Brain is vulnerable to numerous insults that can act in the pre-, peri-, and post-natal period. There is growing evidence that demonstrate how oxidative stress (OS) could represent the final common pathway of all these insults. Fetuses and newborns are particularly vulnerable to OS due to their inability to active the antioxidant defenses. Specific molecules involved in OS could be measured in biologic fluids as early biomarkers of neonatal brain injury with an essential role in neuroprotection. Although S-100B seems to be the most studied biomarker, its use in clinical practice is limited by the complexity of brain damage etiopathogenesis and the time of blood sampling in relation to the brain injury. Reliable early specific serum markers are currently lacking in clinical practice. It is essential to determine if there are specific biomarkers that can help caregivers to monitor the progression of the disease in order to active an early neuroprotective strategy. We aimed to describe, in an educational review, the actual evidence on serum biomarkers for the early identification of newborns at a high risk of neurological diseases. To move the biomarkers from the bench to the bedside, the assays must be not only be of a high sensitivity but suitable for the very rapid processing and return of the results for the clinical practice to act on. For the best prognosis, more studies should focus on the association of these biomarkers to the type and severity of perinatal brain damage.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | - Federica Grassi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Caporilli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giovanni Boscarino
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giulia Carbone
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Lucia Maria Gambini
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Antonio Di Peri
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Sabrina Moretti
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
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Swissa SS, Baron J, Tirosh D, Yaniv-Salem S, Shelef I, Hershkovitz R, Beharier O. S100B in maternal circulation of pregnancies complicated by FGR and brain sparing. Prenat Diagn 2021; 42:141-150. [PMID: 34530488 DOI: 10.1002/pd.6045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/11/2021] [Accepted: 09/09/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine whether the presence of brain sparing in fetal growth restricted (FGR) fetuses involves elevation of the cerebral injury biomarker S100B in maternal circulation. METHODS We included 63 women with suspected small for gestational age (SGA) fetuses between 24 and 35 +6/7 weeks of gestation. Maternal plasma angiogenic factors measurements and sonographic evaluation were performed at recruitment. Next, we subdivided our SGA cohort into three groups: SGA fetuses, FGR fetuses without brain-sparing, and FGR fetuses with brain-sparing (FGR-BS). Serum S100B concentration was calculated as S100B µg/L, S100B MoM, and the ratio S100B/ estimated fetal weight (EFW). We also report one case of S100B concentration surge in maternal serum following the diagnosis of fetal intraventricular hemorrhage (IVH). RESULTS The FGR-BS group had higher maternal S100B µg/L (p < 0.01, p < 0.05, respectively), S100B MoM (p < 0.001, p < 0.001, respectively), and S100B/EFW (p < 0.001, p < 0.01, respectively), compared to the SGA and FGR groups. In the case report, maternal serum S100B concentrations were 0.0346 µg/L before, and 0.0874 µg/L after IVH occurrence. CONCLUSIONS S100B concentration in maternal serum increased in pregnancies complicated by FGR and brain sparing. These results may substantiate in-utero cerebral injury and may explain the adverse neurocognitive outcomes reported for this group.
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Affiliation(s)
- Shani S Swissa
- Department of Obstetrics and Gynecology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Baron
- Department of Obstetrics and Gynecology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shimrit Yaniv-Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilan Shelef
- Department of Radiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Efstathiou N, Slavakis A, Drossou V, Kantziou K, Dermetzoglou V, Soubasi V. Can we delineate brain injury in full-term neonates using serum biomarkers? Brain Inj 2021; 35:821-830. [PMID: 33780304 DOI: 10.1080/02699052.2021.1907862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE: Early identification of neonates at risk of neurological impairment is particularly important for the bedside clinician. Clinical value of S100b and neuron-specific enolase in neonates has not been yet established. We investigated their kinetics and possible early clinical utility in neonatal encephalopathy (NE).STUDY DESIGN: 36 full-term neonates (13 with moderate/severe encephalopathy, 11 with mild encephalopathy, 12 controls) were enrolled and studied prospectively. Serum S100b and neuron-specific enolase (NSE) were measured serially on days(d) 1, 3, 9 and 18 of life. Brain MRI and long-term neurodevelopmental outcome were also assessed.RESULT: Neonates with moderate/severe encephalopathy had significantly increased S100b (d1) and NSE levels (d1, d3, d9) compared to controls. Neuron-specific enolase significantly correlated with the degree of encephalopathy, and a cutoff of 38.8 μg/l (d1) accurately predicted moderate/severe encephalopathy. S100b (d1) cutoff points of 1.6 μg/l and 11.4 μg/l prognosticated severe encephalopathy and death/cerebral palsy, respectively. Both biomarkers correlated well with neuroimaging and Bayley-III scores.CONCLUSION: Combined clinical, laboratory, imaging and neurodevelopmental data indicate that serum S100b and NSE can be useful biomarkers for the diagnosis and prognosis of neonatal brain injury, providing useful information to the bedside clinician.
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Affiliation(s)
- Nikolaos Efstathiou
- 1st Neonatal Department and NICU, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristidis Slavakis
- Biochemistry Department, Hippokration General Hospital, Thessaloniki, Greece
| | - Vasiliki Drossou
- 1st Neonatal Department and NICU, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Kantziou
- 1st Neonatal Department and NICU, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Vasiliki Soubasi
- 2nd Neonatal Department and NICU, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Andersson EA, Mallard C, Ek CJ. Circulating tight-junction proteins are potential biomarkers for blood-brain barrier function in a model of neonatal hypoxic/ischemic brain injury. Fluids Barriers CNS 2021; 18:7. [PMID: 33568200 PMCID: PMC7877092 DOI: 10.1186/s12987-021-00240-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background Neonatal encephalopathy often leads to lifelong disabilities with limited treatments currently available. The brain vasculature is an important factor in many neonatal neurological disorders but there is a lack of diagnostic tools to evaluate the brain vascular dysfunction of neonates in the clinical setting. Measurement of blood–brain barrier tight-junction (TJ) proteins have shown promise as biomarkers for brain injury in the adult. Here we tested the biomarker potential of tight-junctions in the context of neonatal brain injury. Methods The levels of TJ-proteins (occluding, claudin-5, and zonula occludens protein 1) in both blood plasma and cerebrospinal fluid (CSF) as well as blood–brain barrier function via 14C-sucrose (342 Da) and Evans blue extravasation were measured in a hypoxia/ischemia brain-injury model in neonatal rats. Results Time-dependent changes of occludin and claudin-5 levels could be measured in blood and CSF after hypoxia/ischemia with males generally having higher levels than females. The levels of claudin-5 in CSF correlated with the severity of the brain injury at 24 h post- hypoxia/ischemia. Simultaneously, we detected early increase in blood–brain barrier-permeability at 6 and 24 h after hypoxia/ischemia. Conclusions Levels of circulating claudin-5 and occludin are increased after hypoxic/ischemic brain injuries and blood–brain barrier-impairment and have promise as early biomarkers for cerebral vascular dysfunction and as a tool for risk assessment of neonatal brain injuries.
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Affiliation(s)
- E Axel Andersson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, 413 90, Gothenburg, Sweden
| | - Carina Mallard
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, 413 90, Gothenburg, Sweden
| | - C Joakim Ek
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 11, 413 90, Gothenburg, Sweden.
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Park JY, Park CW, Moon KC, Park JS, Jun JK, Lee SJ, Kim JH. Retinopathy of prematurity in infants without fetal growth restriction is decreased with the progression of acute histologic chorioamnionitis: New observation as a protective factor against retinopathy of prematurity. Placenta 2020; 104:161-167. [PMID: 33348284 DOI: 10.1016/j.placenta.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION IGF-1 deficiency in prenatal period is known to be a definite pathophysiology of retinopathy of prematurity(ROP), which is more frequent in infants with fetal growth restriction(FGR). Of note, recent reports demonstrated intra-amniotic inflammation(IAI) closely linked to acute histologic chorioamnionitis(acute-HCA) is associated with a decrease in intact-form of IGFBP-1, ultimately rising the probability of an increase in IGF-1. Therefore, we hypothesized ROP in preterm-infants without FGR would be decreased with the progression of acute-HCA. METHODS The frequency of ROP was examined in 85 singleton preterm-infants(24.5weeks ≤ gestational-age[GA] at delivery<30weeks) due to either preterm-labor and intact-membranes(PTL) or preterm premature rupture of membranes(preterm-PROM) without FGR(birth-weight<5th percentile for GA). Patients were divided according to the progression of inflammation in extra-placental membranes(EPM) and the progression of inflammation in chorionic-vessel(CV) and umbilical-cord(UC). RESULTS 1) ROP was present in 40%(34/85) of study-population; 2) Of note, there was a significant stepwise-decrease in ROP with the progression of inflammation in EPM(inflammation-free EPM vs. inflammation restricted to CD vs. amnionitis; 55.6%[15/27]vs.39.5%[17/43]vs.13.3%[2/15]) and the progression of inflammation in CV and UC(inflammation-free CV and UC vs. inflammation restricted to CV and umbilical vessels vs. inflammation in Wharton's jelly[WJ]; 49.2%[29/59]vs.25.0%[3/12]vs.14.3%[2/14])(each-for P < 0.05, Chi-square test and each-for P < 0.01, linear-by-linear association); 3) Multiple logistic-regression analysis demonstrated amnionitis(Odds-Ratio 0.120, 95%Confidence-Interval 0.022-0.654, P = 0.014) and inflammation in WJ(Odds-Ratio 0.124, 95%Confidence-Interval 0.022-0.694, P = 0.018) were independent protective-factors against ROP. DISCUSSION ROP in preterm-infants due to PTL or preterm-PROM without FGR is decreased with the progression of acute-HCA. This finding may be an evidence to suggest the progression of acute-HCA is closely associated with reducing the pathophysiology of ROP.
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Affiliation(s)
- Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Reproductive Medicine and Population, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Reproductive Medicine and Population, Seoul National University Medical Research Center, Seoul, South Korea
| | - Seok Jae Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Hun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.
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Catherine RC, Bhat BV, Adhisivam B, Bharadwaj SK, Vinayagam V, Chinnakali P. Neuronal Biomarkers in Predicting Neurodevelopmental Outcome in Term Babies with Perinatal Asphyxia. Indian J Pediatr 2020; 87:787-792. [PMID: 32415664 DOI: 10.1007/s12098-020-03283-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 03/30/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess whether serum levels of neuronal biomarkers (S100 calcium-binding protein B and Neuron specific enolase) correlate with the neurodevelopmental outcome of term neonates at 18 mo who had hypoxic ischemic encephalopathy and underwent therapeutic hypothermia. METHODS This randomized controlled trial was conducted in a tertiary care teaching hospital, south India. There were 162 term infants with moderate to severe hypoxic ischemic encephalopathy who were randomized into 2 groups (Group A and B). Neonates in Group A and B received normothermia and therapeutic hypothermia respectively. Serum levels of neuronal biomarkers were estimated at 0, 24 (±1) and 72 (±1) h after birth using sandwich ELISA in both groups. All neonates were carefully monitored till discharge. Infants who survived the neonatal period were followed up in the high risk clinic for 18 mo and neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Neurodevelopmental outcomes between the two groups were compared using Chi square test and neuronal biomarker levels between the groups were compared using Mann Whitney test. RESULTS The baseline maternal and neonatal characteristics in both groups were comparable. There was statistically insignificant lesser mortality in therapeutic hypothermia group compared to normothermia group with Risk Ratio (RR): 0.82 (28.2% vs. 34.5%, 95% CI: 0.52-1.29, p = 0.38). Among the survivors, children in therapeutic hypothermia group had better motor and mental scores compared to those in normothermia group at 18 mo. There was no significant correlation between S100B and Neuron specific enolase levels and neurodevelopmental outcome. CONCLUSIONS Serum levels of neuronal biomarkers (S100B and Neuron specific enolase) do not correlate with the long term neurodevelopmental outcome among these infants.
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Affiliation(s)
- R Christina Catherine
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - B Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India. .,Department of Pediatrics and Neonatology, AVMC, Kirumampakkam, Puducherry, 607402, India.
| | - B Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Shruthi K Bharadwaj
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Vickneshwaran Vinayagam
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Palanivel Chinnakali
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Borjini N, Sivilia S, Giuliani A, Fernandez M, Giardino L, Facchinetti F, Calzà L. Potential biomarkers for neuroinflammation and neurodegeneration at short and long term after neonatal hypoxic-ischemic insult in rat. J Neuroinflammation 2019; 16:194. [PMID: 31660990 PMCID: PMC6819609 DOI: 10.1186/s12974-019-1595-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypoxic-ischemic (HI) encephalopathy causes life-long morbidity and premature mortality in term neonates. Therapies in addition to whole-body cooling are under development to treat the neonate at risk for HI encephalopathy, but are not a quickly measured serum inflammatory or neuronal biomarkers to rapidly and accurately identify brain injury in order to follow the efficacy of therapies. METHODS In order to identify potential biomarkers for early inflammatory and neurodegenerative events after neonatal hypoxia-ischemia, both male and female Wistar rat pups at postnatal day 7 (P7) were used and had their right carotid artery permanently doubly occluded and exposed to 8% oxygen for 90 min. Sensory and cognitive parameters were assessed by open field, rotarod, CatWalk, and Morris water maze (MWM) test. Plasma and CSF biomarkers were investigated on the acute (24 h and 72 h) and chronic phase (4 weeks). Brains were assessed for gene expression analysis by quantitative RT-PCR Array. RESULTS We found a delay of neurological reflex maturation in HI rats. We observed anxiolytic-like baseline behavior in males more than females following HI injury. HI rats held on the rotarod for a shorter time comparing to sham. HI injury impaired spatial learning ability on MWM test. The CatWalk assessment demonstrated a long-term deficit in gait parameters related to the hind paw. Proinflammatory biomarkers such as IL-6 in plasma and CCL2 and TNF-α in CSF showed an upregulation at 24 h after HI while other cytokines, such as IL-17A and CCL5, were upregulated after 72 h in CSF. At 24 h post-injury, we observed an increase of Edn1, Hif1-α, and Mmp9 mRNA levels in the ipsilateral vs the contralateral hemisphere of HI rats. An upregulation of genes involved with clotting and hematopoietic processes was observed 72 h post-injury. CONCLUSIONS Our work showed that, in the immature brain, the HI injury induced an early increased production of several proinflammatory mediators detectable in plasma and CSF, followed by tissue damage in the hypoxic hemisphere and short-term as well as long-lasting neurobehavioral deficits.
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Affiliation(s)
- Nozha Borjini
- Corporate Pre-clinical R&D, Chiesi Farmaceutici S.p.A, Largo Belloli 11/A, 43122, Parma, Italy. .,Health Science and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Via Tolara di Sopra 41/E, I-40064, Ozzano Emilia, BO, Italy. .,IRET Foundation, Via Tolara di Sopra 41/E, 40064, Ozzano Emilia, BO, Italy.
| | - Sandra Sivilia
- IRET Foundation, Via Tolara di Sopra 41/E, 40064, Ozzano Emilia, BO, Italy
| | - Alessandro Giuliani
- IRET Foundation, Via Tolara di Sopra 41/E, 40064, Ozzano Emilia, BO, Italy.,Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano Emilia, BO, Italy
| | - Mercedes Fernandez
- IRET Foundation, Via Tolara di Sopra 41/E, 40064, Ozzano Emilia, BO, Italy.,Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano Emilia, BO, Italy
| | - Luciana Giardino
- Health Science and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Via Tolara di Sopra 41/E, I-40064, Ozzano Emilia, BO, Italy.,IRET Foundation, Via Tolara di Sopra 41/E, 40064, Ozzano Emilia, BO, Italy.,Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano Emilia, BO, Italy
| | - Fabrizio Facchinetti
- Corporate Pre-clinical R&D, Chiesi Farmaceutici S.p.A, Largo Belloli 11/A, 43122, Parma, Italy
| | - Laura Calzà
- Health Science and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Via Tolara di Sopra 41/E, I-40064, Ozzano Emilia, BO, Italy.,IRET Foundation, Via Tolara di Sopra 41/E, 40064, Ozzano Emilia, BO, Italy.,Department of Pharmacy and Biotechnology, University of Bologna, Via Tolara di Sopra 41, 40064, Ozzano Emilia, BO, Italy
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Luo Q, Pin T, Dai L, Chen G, Chen Y, Tian F, Zhang M. The Role of S100B Protein at 24 Hours of Postnatal Age as Early Indicator of Brain Damage and Prognostic Parameter of Perinatal Asphyxia. Glob Pediatr Health 2019; 6:2333794X19833729. [PMID: 31044150 PMCID: PMC6446251 DOI: 10.1177/2333794x19833729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction. S100B protein is a cytosolic calcium-binding protein with a molecular weight of 21 kDa, which is present in various cells and concentrated mainly in the glial cells, which play a vital role in the maintenance of cellular homeostasis in the central nervous system. It is possible that increased S100B protein level might be considered as sensitive and specific indicator to predict early brain damage. Aim. To investigate the prognostic value of serum S100B protein in neonates with perinatal asphyxia (PA) at 24 hours of postnatal age. Methods. A systematic review was performed. Inclusion criteria were studies including data of neonates with PA, monitored with serum S100B, and with neurodevelopmental follow-up of at least 2 weeks. The period of bibliographic search was until January 2017. The consulted databases were MEDLINE, PsycINFO, and Embase. A combination of the following subject headings and keywords was adapted for each electronic database: “perinatal asphyxia,” “hypoxic ischemic encephalopathy,” “hypoxia-ischemia, brain,” and “S100B.” Meta-Disc1.4 software was used. Results. From the 1620 articles initially identified, 6 were finally included and reviewed. The overall diagnostic sensitivity of serum S100B was 0.80 (95% confidence interval [CI] = 0.68-0.88) and the specificity was 0.79 (95% CI = 0.70-0.87). But there was lower predictability value, that is, the positive likelihood ratio was only 3.26 (95% CI 1.74-6.12) and the negative likelihood ratio was 0.32 (95% CI = 0.20-0.5). The diagnostic odds ratio was 12.40 (95% CI = 4.66-33.0). Conclusion. Increased serum S100B level at 24 hours of postnatal life can demonstrate brain damage, but it should not be the only one used to predict PA outcome.
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Affiliation(s)
- Qiu Luo
- Kunming Medical University Second Hospital, Kunming, China
| | - Tamis Pin
- The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - LiFen Dai
- Kunming Medical University Second Hospital, Kunming, China
| | - GuiXian Chen
- Kunming Medical University Second Hospital, Kunming, China
| | - YuTong Chen
- Kunming Medical University Second Hospital, Kunming, China
| | - FuLu Tian
- Kunming Medical University Second Hospital, Kunming, China
| | - Man Zhang
- Kunming Medical University Second Hospital, Kunming, China
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Massaro AN, Wu YW, Bammler TK, Comstock B, Mathur A, McKinstry RC, Chang T, Mayock DE, Mulkey SB, Van Meurs K, Juul S. Plasma Biomarkers of Brain Injury in Neonatal Hypoxic-Ischemic Encephalopathy. J Pediatr 2018; 194:67-75.e1. [PMID: 29478510 DOI: 10.1016/j.jpeds.2017.10.060] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/21/2017] [Accepted: 10/25/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate plasma brain specific proteins and cytokines as biomarkers of brain injury in newborns with hypoxic-ischemic encephalopathy (HIE) and, secondarily, to assess the effect of erythropoietin (Epo) treatment on the relationship between biomarkers and outcomes. STUDY DESIGN A study of candidate brain injury biomarkers was conducted in the context of a phase II multicenter randomized trial evaluating Epo for neuroprotection in HIE. Plasma was collected at baseline (<24 hours) and on day 5. Brain injury was assessed by magnetic resonance imaging (MRI) and neurodevelopmental assessments at 1 year. The relationships between Epo, brain-specific proteins (S100B, ubiquitin carboxy-terminal hydrolase-L1 [UCH-L1], total Tau, neuron specific enolase), cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, IL-12P70, IL-13, interferon-gamma [IFN-γ], tumor necrosis factor alpha [TNF-α], brain-derived neurotrophic factor [BDNF], monocyte chemoattractant protein-1), and brain injury were assessed. RESULTS In 50 newborns with encephalopathy, elevated baseline S100B, Tau, UCH-L1, IL-1β, IL-6, IL-8, IL-10, IL-13, TNF-α, and IFN-γ levels were associated with increasing brain injury severity by MRI. Higher baseline Tau and lower day 5 BDNF were associated with worse 1 year outcomes. No statistically significant evidence of Epo treatment modification on biomarkers was detected in this small cohort. CONCLUSIONS Elevated plasma brain-specific proteins and cytokine levels in the first 24 hours of life are associated with worse brain injury by MRI in newborns with HIE. Only Tau and BDNF levels were found to be related to neurodevelopmental outcomes. The effect of Epo treatment on the relationships between biomarkers and brain injury in HIE requires further study. TRIAL REGISTRATION ClinicalTrials.gov: 01913340.
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Affiliation(s)
- An N Massaro
- Department of Pediatrics, The George Washington University School of Medicine and Children's National Health Systems, Washington, DC.
| | - Yvonne W Wu
- Department of Neurology, University of California, San Francisco, San Francisco, CA; Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Theo K Bammler
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA
| | - Bryan Comstock
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Amit Mathur
- Department of Pediatrics, Washington University, St Louis, MO
| | - Robert C McKinstry
- Department of Pediatrics, Washington University, St Louis, MO; Department of Radiology, Washington University, St Louis, MO
| | - Taeun Chang
- Department of Pediatrics, The George Washington University School of Medicine and Children's National Health Systems, Washington, DC; Department of Neurology, The George Washington University School of Medicine and Children's National Health Systems, Washington, DC
| | - Dennis E Mayock
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Sarah B Mulkey
- Department of Pediatrics, The George Washington University School of Medicine and Children's National Health Systems, Washington, DC; Department of Neurology, The George Washington University School of Medicine and Children's National Health Systems, Washington, DC
| | - Krisa Van Meurs
- Department of Pediatrics, Stanford University, Palo Alto, CA
| | - Sandra Juul
- Department of Pediatrics, University of Washington, Seattle, WA
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10
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Serpero LD, Bianchi V, Pluchinotta F, Conforti E, Baryshnikova E, Guaschino R, Cassinari M, Trifoglio O, Calevo MG, Gazzolo D. S100B maternal blood levels are gestational age- and gender-dependent in healthy pregnancies. Clin Chem Lab Med 2017; 55:1770-1776. [PMID: 28282292 DOI: 10.1515/cclm-2016-1127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND S100B is a well-established biomarker of central nervous system (CNS) development and damage in the perinatal period. Because the fetal CNS induces an overproduction of S100B measurable in the maternal bloodstream we evaluated S100B protein in healthy pregnancies in order to provide a reference curve of the protein in the second and third trimesters and to provide information on CNS development when standard monitoring procedures could be silent or unavailable. METHODS Between July 2012 and December 2014 we conducted a prospective study in 1213 healthy pregnancies delivering healthy newborns. Maternal blood samples were collected for standard monitoring procedures and S100B assessment. S100B correlations with selected outcomes (gestational age at sampling, gender of fetus, gestational age and weight at birth, delivery mode) were calculated using multiple forward stepwise regression analysis. RESULTS S100B concentrations in the second and third trimesters of pregnancy were found to be gestational age-, gender- and delivery mode-dependent (p<0.05, for all). Multiple forward stepwise regression analysis with S100B as the dependent variable and gestational age at sampling, gender, delivery mode, gestational age and weight at birth as independent variables, showed a significant correlation between S100B and gestational age at sampling (R=0.13; p<0.001). CONCLUSIONS The present findings offering a S100B protein reference curve in maternal blood suggest that non-invasive fetal CNS monitoring is becoming feasible and open the way to further research in neuro-biomarker assessment in the maternal bloodstream.
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Zaigham M, Lundberg F, Olofsson P. Protein S100B in umbilical cord blood as a potential biomarker of hypoxic-ischemic encephalopathy in asphyxiated newborns. Early Hum Dev 2017; 112:48-53. [PMID: 28756088 DOI: 10.1016/j.earlhumdev.2017.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/29/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neonatal hypoxic ischemic encephalopathy (HIE) is a devastating condition resulting from a sustained lack of oxygen during birth. The interest in identifying a relevant biomarker of HIE has thrown into limelight the role of protein S100B as a clinical diagnostic marker of hypoxic brain damage in neonates. AIMS To evaluate the diagnostic value of protein S100B, measured in umbilical cord blood immediately after birth, as a useful biomarker in the diagnosis of HIE Sarnat stages II-III as well as a marker for long-term mortality and morbidity. STUDY DESIGN Protein S100B was analyzed in cord blood sampled at birth from 13 newborns later diagnosed with stage II-III HIE and compared with 21 healthy controls. S100B concentrations were related to cord artery pH, amplitude-integrated electroencephalography (aEEG), stage of HIE, and death/sequelae up to an age of 6years. Both parametric and non-parametric statistics were used with a two-sided P<0.05 considered significant. RESULTS The difference in S100B concentration was marginally statistically significant between HIE cases and controls (P=0.056). Cord blood acidosis (P=0.046), aEEG pattern severity (P=0.030), HIE severity (P=0.027), and condition at 6-year follow-up (healthy/permanent sequelae/death; P=0.027) were all related to an increase in S100B concentration. CONCLUSIONS Protein S100B in neonates suffering from HIE stages II-III appeared elevated in umbilical cord blood at birth. The S100B concentrations were positively associated to the severity of disease and the risk of suffering from neurodevelopmental sequelae and even death.
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Affiliation(s)
- Mehreen Zaigham
- Institution of Clinical Sciences Malmö, Lund University, Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.
| | - Fredrik Lundberg
- Institution of Clinical Sciences Malmö, Lund University, Dept. of Pediatric Medicine, Skåne University Hospital, Malmö, Sweden
| | - Per Olofsson
- Institution of Clinical Sciences Malmö, Lund University, Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
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12
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Toorell H, Zetterberg H, Blennow K, Sävman K, Hagberg H. Increase of neuronal injury markers Tau and neurofilament light proteins in umbilical blood after intrapartum asphyxia. J Matern Fetal Neonatal Med 2017. [PMID: 28629249 DOI: 10.1080/14767058.2017.1344964] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM Compare the levels of the brain injury biomarkers Tau and neurofilament light protein (NFL) in cases of asphyxia with those in controls. MATERIALS AND METHODS We analyzed the neuronal proteins Tau and NFL in umbilical blood of 10 cases of severe-moderate intrapartum asphyxia and in 18 control cases. RESULTS The levels of both Tau and neurofilament were significantly higher after asphyxia and it appeared to be a correlation between the levels of the biomarkers and the severity of the insult. DISCUSSION Future studies are warranted to support or refute the value of Tau/NFLin clinical practice. CONCLUSION Fetal asphyxia remains a clinical problem resulting in life-long neurological disabilities. We urgently need more accurate early predictive markers to direct the clinician when to provide neuroprotective therapy.
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Affiliation(s)
- Hanna Toorell
- a Perinatal Center, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Henrik Zetterberg
- b Clinical Neurochemistry Laboratory , Mölndal , Sweden.,c Department of Psychiatry and Neurochemistry , Institute of Neuroscience and Physiology , Mölndal , Sweden.,d Department of Molecular Neuroscience , UCL Institute of Neurology, University College London , London , UK
| | - Kaj Blennow
- b Clinical Neurochemistry Laboratory , Mölndal , Sweden.,c Department of Psychiatry and Neurochemistry , Institute of Neuroscience and Physiology , Mölndal , Sweden
| | - Karin Sävman
- e Department of Pediatrics , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden
| | - Henrik Hagberg
- a Perinatal Center, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.,f Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering , King's College London, St. Thomas' Hospital , London , UK
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13
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Plomgaard AM, Alderliesten T, Austin T, van Bel F, Benders M, Claris O, Dempsey E, Fumagalli M, Gluud C, Hagmann C, Hyttel-Sorensen S, Lemmers P, van Oeveren W, Pellicer A, Petersen TH, Pichler G, Winkel P, Greisen G. Early biomarkers of brain injury and cerebral hypo- and hyperoxia in the SafeBoosC II trial. PLoS One 2017; 12:e0173440. [PMID: 28328980 PMCID: PMC5362210 DOI: 10.1371/journal.pone.0173440] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The randomized clinical trial, SafeBoosC II, examined the effect of monitoring of cerebral oxygenation by near-infrared spectroscopy combined with a guideline on treatment when cerebral oxygenation was out of the target range. Data on cerebral oxygenation was collected in both the intervention and the control group. The primary outcome was the reduction in the burden of cerebral hypo- and hyperoxia between the two groups. In this study we describe the associations between the burden of cerebral hypo- and hyperoxia, regardless of allocation to intervention or control group, and the biomarkers of brain injury from birth till term equivalent age that was collected as secondary and explorative outcomes in the SafeBoosC II trial. METHODS Cerebral oxygenation was continuously monitored during the first 72h of life in 166 extremely preterm infants. Cranial ultrasound was performed at day 1,4,7,14, and 35 and at term. Electroencephalogram (EEG) was recorded at 64h. Blood-samples taken at 6 and 64 hours were analysed for the brain injury biomarkers; S100beta, brain-fatty-acid-binding-protein, and neuroketal. All analyses were conducted post hoc. RESULTS Significantly more infants with a cerebral burden of hypoxia within the 4th quartile versus infants within quartile 1-3 were diagnosed with severe intracranial haemorrhage (11/39 versus 11/117, p = 0.003), had low burst rate on EEG (12/28 versus 21/103, p = 0.015), or died (14/41 versus 18/123, p = 0.006), whereas none of these events were significantly associated with cerebral hyperoxia. The blood biomarkers were not significantly associated with the burden of cerebral hypo- or hyperoxia. CONCLUSIONS The explorative analysis showed that early burden of cerebral hypoxia, but not hyperoxia was significantly associated with low brain electrical activity and severe intracranial haemorrhage while none of the three blood biomarkers were associated with the burden of either cerebral hypo- or hyperoxia.
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Affiliation(s)
- Anne M. Plomgaard
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Alderliesten
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Topun Austin
- Rosie Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Frank van Bel
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Manon Benders
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | | | - Monica Fumagalli
- NICU,Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cornelia Hagmann
- Clinic of Neonatology, University of Zurich, Zurich, Switzerland
| | - Simon Hyttel-Sorensen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Petra Lemmers
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | | | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Tue H. Petersen
- Research Unit on Brain Injury Neurorehabilitation Copenhagen, Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
| | - Gerhard Pichler
- Department of Pediatrics, Research Unit for Neonatal Micro- and Macrocirculation, Medical University of Graz, Graz, Austria
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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14
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Lei J, Paules C, Nigrini E, Rosenzweig JM, Bahabry R, Farzin A, Yang S, Northington FJ, Oros D, McKenney S, Johnston MV, Graham EM, Burd I. Umbilical Cord Blood NOS1 as a Potential Biomarker of Neonatal Encephalopathy. Front Pediatr 2017; 5:112. [PMID: 28649562 PMCID: PMC5466059 DOI: 10.3389/fped.2017.00112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There are no definitive markers to aid in diagnosis of neonatal encephalopathy (NE). The purpose of our study was (1) to identify and evaluate the utility of neuronal nitric oxide synthase (NOS1) in umbilical cord blood as a NE biomarker and (2) to identify the source of NOS1 in umbilical cord blood. METHODS This was a nested case-control study of neonates >35 weeks of gestation. ELISA for NOS1 in umbilical cord blood was performed. Sources of NOS1 in umbilical cord were investigated by immunohistochemistry, western blot, ELISA, and quantitative PCR. Furthermore, umbilical cords of full-term neonates were subjected to 1% hypoxia ex vivo. RESULTS NOS1 was present in umbilical cord blood and increased in NE cases compared with controls. NOS1 was expressed in endothelial cells of the umbilical cord vein, but not in artery or blood cells. In ex vivo experiments, hypoxia was associated with increased levels of NOS1 in venous endothelial cells of the umbilical cord as well as in ex vivo culture medium. CONCLUSION This is the first study to investigate an early marker of NE. NOS1 is elevated with hypoxia, and further studies are needed to investigate it as a valuable tool for early diagnosis of neonatal brain injury.
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Affiliation(s)
- Jun Lei
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cristina Paules
- Aragón Health Research Institute, SAMID Network ref RD12/0026/001, Zaragoza, Spain
| | - Elisabeth Nigrini
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason M Rosenzweig
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rudhab Bahabry
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Azadeh Farzin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samuel Yang
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frances J Northington
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Oros
- Aragón Health Research Institute, SAMID Network ref RD12/0026/001, Zaragoza, Spain
| | - Stephanie McKenney
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael V Johnston
- Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurosciences, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ernest M Graham
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurosciences, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Plomgaard AM, van Oeveren W, Petersen TH, Alderliesten T, Austin T, van Bel F, Benders M, Claris O, Dempsey E, Franz A, Fumagalli M, Gluud C, Hagmann C, Hyttel-Sorensen S, Lemmers P, Pellicer A, Pichler G, Winkel P, Greisen G. The SafeBoosC II randomized trial: treatment guided by near-infrared spectroscopy reduces cerebral hypoxia without changing early biomarkers of brain injury. Pediatr Res 2016; 79:528-35. [PMID: 26679155 PMCID: PMC4840238 DOI: 10.1038/pr.2015.266] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/30/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The SafeBoosC phase II multicentre randomized clinical trial investigated the benefits and harms of monitoring cerebral oxygenation by near-infrared spectroscopy (NIRS) combined with an evidence-based treatment guideline vs. no NIRS data and treatment as usual in the control group during the first 72 h of life. The trial demonstrated a significant reduction in the burden of cerebral hypoxia in the experimental group. We now report the blindly assessed and analyzed treatment effects on electroencephalographic (EEG) outcomes (burst rate and spectral edge frequency 95% (SEF95)) and blood biomarkers of brain injury (S100β, brain fatty acid-binding protein, and neuroketal). METHODS One hundred and sixty-six extremely preterm infants were randomized to either experimental or control group. EEG was recorded at 64 h of age and blood samples were collected at 6 and 64 h of age. RESULTS One hundred and thirty-three EEGs were evaluated. The two groups did not differ regarding burst rates (experimental 7.2 vs. control 7.7 burst/min) or SEF95 (experimental 18.1 vs. control 18.0 Hz). The two groups did not differ regarding blood S100β, brain fatty acid-binding protein, and neuroketal concentrations at 6 and 64 h (n = 123 participants). CONCLUSION Treatment guided by NIRS reduced the cerebral burden of hypoxia without affecting EEG or the selected blood biomarkers.
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Affiliation(s)
- Anne M. Plomgaard
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Tue H. Petersen
- Research Unit on Brain Injury Neurorehabilitation Copenhagen, Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
| | - Thomas Alderliesten
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Topun Austin
- Rosie Maternity Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Frank van Bel
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon Benders
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olivier Claris
- Department of Neonatology, Hospital Femme Mere Enfants, Bron, France
| | | | - Axel Franz
- Department of Neonatology, University of Tuebingen, Tübingen, Germany
| | - Monica Fumagalli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cornelia Hagmann
- Department of Neonatology, University of Zurich, Zurich, Switzerland
| | - Simon Hyttel-Sorensen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Petra Lemmers
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Abstract
Neonatal encephalopathy (NE) is a major contributor to neurodevelopmental deficits including cerebral palsy in term and near-term infants. The long-term neurodevelopmental outcome is difficult to predict with certainty in first few days of life. Multiorgan involvement is common but not part of the diagnostic criteria for NE. The most frequently involved organs are the heart, liver, kidneys and hematological system. Cerebral and organ involvement is associated with the release of organ specific biomarkers in cerebrospinal fluid, urine and blood. These biomarkers may have a role in the assessment of the severity of asphyxia and long-term outcome in neonates with NE.
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Affiliation(s)
- Saima Aslam
- Department of Paediatrics, National Maternity Hospital, Holles Street, Dublin, Ireland
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17
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Sarici D, Gunes T, Yazici C, Akin MA, Korkmaz L, Memur S, Kurtoglu S, Ozturk MA, Sarici SU. Investigation on malondialdehyde, S100B, and advanced oxidation protein product levels in significant hyperbilirubinemia and the effect of intensive phototherapy on these parameters. Pediatr Neonatol 2015; 56:95-100. [PMID: 25261050 DOI: 10.1016/j.pedneo.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/25/2014] [Accepted: 06/19/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The parameters of oxidative stress [advanced oxidation protein products (AOPPs), malondialdehyde (MDA), and S100B] and the effect of intensive phototherapy (PT) on these parameters have not been studied extensively in newborns with significant hyperbilirubinemia (SH). We aimed to measure the levels of MDA, S100B, and AOPPs in newborns with SH, and to compare newborns with healthy control newborns without hyperbilirubinemia on the basis of these parameters of oxidative stress. In addition, we investigated the effect of intensive PT on these parameters during the treatment of SH and report our findings for the first time in the literature. METHODS The study was performed in newborns (n = 62) who underwent intensive PT because of SH. Newborns without jaundice constituted the control group (n = 30). Both groups were compared with respect to demographic characteristics and biochemical (laboratory) parameters including MDA, AOPPs, and S100B. MDA, AOPPs, and S100B were also compared before and after intensive PT in the PT group. In the study group, a correlation analysis of demographic characteristics; MDA, AOPP, and S100B values; and changes occurring in MDA, AOPPs, and S100B values due to the effect of intensive PT was performed. RESULTS Serum total bilirubin, S100B, and MDA levels in the PT group before performing PT were significantly higher than those in the control group. In newborns receiving PT serum total bilirubin, MDA and AOPP levels decreased significantly after intensive PT. In correlation analysis, a statistically significant negative correlation was found only between the amount of bilirubin decrease with PT and AOPP levels after PT in the study group. CONCLUSION Whether the significant decrease in MDA levels, which was higher prior to PT, is due to the decrease in serum bilirubin levels or due to the effect of intensive PT itself remains to be determined in further studies. The decrease in AOPP levels after PT implies that intensive PT has protective effects on oxidative stress.
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Affiliation(s)
- Dilek Sarici
- Division of Neonatology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey.
| | - Tamer Gunes
- Division of Neonatology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Cevat Yazici
- Department of Biochemistry, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Mustafa Ali Akin
- Division of Neonatology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Levent Korkmaz
- Division of Neonatology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Seyma Memur
- Division of Neonatology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Selim Kurtoglu
- Division of Neonatology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Adnan Ozturk
- Division of Neonatology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Serdar Umit Sarici
- Division of Neonatology, Department of Pediatrics, Ufuk University Faculty of Medicine, Ankara, Turkey
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19
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Biomarkers S100B and neuron-specific enolase predict outcome in hypothermia-treated encephalopathic newborns*. Pediatr Crit Care Med 2014; 15:615-22. [PMID: 24777302 PMCID: PMC4376375 DOI: 10.1097/pcc.0000000000000155] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate if serum S100B protein and neuron-specific enolase measured during therapeutic hypothermia are predictive of neurodevelopmental outcome at 15 months in children with neonatal encephalopathy. DESIGN Prospective longitudinal cohort study. SETTING A level IV neonatal ICU in a freestanding children's hospital. PATIENTS Term newborns with moderate to severe neonatal encephalopathy referred for therapeutic hypothermia during the study period. INTERVENTIONS Serum neuron-specific enolase and S100B were measured at 0, 12, 24, and 72 hours of hypothermia. MEASUREMENTS AND MAIN RESULTS Of the 83 infants enrolled, 15 (18%) died in the newborn period. Survivors were evaluated by the Bayley Scales of Infant Development-II at 15 months. Outcomes were assessed in 49 of 68 survivors (72%) at a mean age of 15.2 ± 2.7 months. Neurodevelopmental outcome was classified by Bayley Scales of Infant Development-II Mental Developmental Index and Psychomotor Developmental Index scores, reflecting cognitive and motor outcomes, respectively. Four-level outcome classifications were defined a priori: normal = Mental Developmental Index/Psychomotor Developmental Index within 1 SD (> 85), mild = Mental Developmental Index/Psychomotor Developmental Index less than 1 SD (70-85), moderate/severe = Mental Developmental Index/Psychomotor Developmental Index less than 2 SD (< 70), or died. Elevated serum S100B and neuron-specific enolase levels measured during hypothermia were associated with increasing outcome severity after controlling for baseline and socioeconomic characteristics in ordinal regression models. Adjusted odds ratios for cognitive outcome were 2.5 (95% CI, 1.3-4.8) for S100B and 2.1 (95% CI, 1.2-3.6) for neuron-specific enolase, and for motor outcome, 2.6 (95% CI, 1.2-5.6) for S100B and 2.1 (95% CI, 1.2-3.6) for neuron-specific enolase. CONCLUSIONS Serum S100B and neuron-specific enolase levels in babies with neonatal encephalopathy are associated with neurodevelopmental outcome at 15 months. These putative biomarkers of brain injury may help direct care during therapeutic hypothermia.
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20
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Beharier O, Shusterman E, Eshcoli T, Szaingurten-Solodkin I, Aricha-Tamir B, Weintraub AY, Sheiner E, Holcberg G, Hershkovitz R. Detection of S100B in maternal blood before and after fetal death. Prenat Diagn 2013; 34:94-7. [PMID: 24178516 DOI: 10.1002/pd.4266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/23/2013] [Accepted: 10/21/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND S100B is a brain damage biomarker. When measured immediately after birth, it reflects neonatal brain damage following asphyxia. In this study, we used feticide as a novel model of fetal brain damage. We examined whether such damage is reflected by a rise in S100B in maternal blood before delivery. METHODS Eight pregnant women were recruited between January and July 2012. Maternal blood samples were drawn before and after feticide at predetermined time points (0, 15, 30, 60, 120, and 240 min). S100B, lactate dehydrogenase, creatine kinase, and creatinine concentrations were measured by standard human ELISA and chemical analyzer. RESULTS No significant difference was noted between S100B levels before and after feticide, neither in non-specific cell death markers (lactate dehydrogenase and creatine kinase), which remained within normal range. S100B ranged between 0.015-0.04 µg/L through all the predetermined time points. CONCLUSION No statistically significant differences were demonstrated in S100B levels before and after feticide.
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Affiliation(s)
- Ofer Beharier
- Department of Obstetrics & Gynecology, Soroka University Medical Center, Beer Sheva, Israel
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21
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To cool or not to cool: does neonatal cord blood provide the answer? Pediatr Crit Care Med 2013; 14:650-1. [PMID: 23823203 DOI: 10.1097/pcc.0b013e3182982376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Serum biomarkers of MRI brain injury in neonatal hypoxic ischemic encephalopathy treated with whole-body hypothermia: a pilot study. Pediatr Crit Care Med 2013; 14:310-7. [PMID: 23392373 PMCID: PMC4420174 DOI: 10.1097/pcc.0b013e3182720642] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine if candidate biomarkers, ubiquitin carboxyl-terminal esterase L1 and glial fibrillary acidic protein, are elevated in neonates with hypoxic ischemic encephalopathy who die or have severe MRI injury compared with surviving infants with minimal or no injury on brain MRI. DESIGN Prospective observational study. SETTING Level IIIC outborn neonatal ICU in a free-standing children's hospital. PATIENTS Term newborns with moderate-to-severe hypoxic ischemic encephalopathy referred for therapeutic hypothermia INTERVENTIONS Serum specimens were collected at 0, 12, 24, and 72 hours of cooling. MRI was performed in surviving infants at target 7-10 days of life and was scored by a pediatric neuroradiologist masked to biomarker and clinical data. MEASUREMENTS AND MAIN RESULTS Serial biomarker levels were determined in 20 hypoxic ischemic encephalopathy patients. Ubiquitin carboxyl-terminal esterase L1 was higher at initiation and 72 hours of cooling, while glial fibrillary acidic protein was higher at 24 and 72 hours in babies with adverse outcome compared with those with favorable outcome. CONCLUSIONS This preliminary data support further studies to evaluate ubiquitin carboxyl-terminal esterase L1 and glial fibrillary acidic protein as immediate biomarkers of cerebral injury severity in newborns with hypoxic ischemic encephalopathy.
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Walsh BH, Broadhurst DI, Mandal R, Wishart DS, Boylan GB, Kenny LC, Murray DM. The metabolomic profile of umbilical cord blood in neonatal hypoxic ischaemic encephalopathy. PLoS One 2012; 7:e50520. [PMID: 23227182 PMCID: PMC3515614 DOI: 10.1371/journal.pone.0050520] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/23/2012] [Indexed: 02/08/2023] Open
Abstract
Background Hypoxic ischaemic encephalopathy (HIE) in newborns can cause significant long-term neurological disability. The insult is a complex injury characterised by energy failure and disruption of cellular homeostasis, leading to mitochondrial damage. The importance of individual metabolic pathways, and their interaction in the disease process is not fully understood. The aim of this study was to describe and quantify the metabolomic profile of umbilical cord blood samples in a carefully defined population of full-term infants with HIE. Methods and Findings The injury severity was defined using both the modified Sarnat score and continuous multichannel electroencephalogram. Using these classification systems, our population was divided into those with confirmed HIE (n = 31), asphyxiated infants without encephalopathy (n = 40) and matched controls (n = 71). All had umbilical cord blood drawn and biobanked at −80°C within 3 hours of delivery. A combined direct injection and LC-MS/MS assay (AbsolutIDQ p180 kit, Biocrates Life Sciences AG, Innsbruck, Austria) was used for the metabolomic analyses of the samples. Targeted metabolomic analysis showed a significant alteration between study groups in 29 metabolites from 3 distinct classes (Amino Acids, Acylcarnitines, and Glycerophospholipids). 9 of these metabolites were only significantly altered between neonates with Hypoxic ischaemic encephalopathy and matched controls, while 14 were significantly altered in both study groups. Multivariate Discriminant Analysis models developed showed clear multifactorial metabolite associations with both asphyxia and HIE. A logistic regression model using 5 metabolites clearly delineates severity of asphyxia and classifies HIE infants with AUC = 0.92. These data describe wide-spread disruption to not only energy pathways, but also nitrogen and lipid metabolism in both asphyxia and HIE. Conclusion This study shows that a multi-platform targeted approach to metabolomic analyses using accurately phenotyped and meticulously biobanked samples provides insight into the pathogenesis of perinatal asphyxia. It highlights the potential for metabolomic technology to develop a diagnostic test for HIE.
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Affiliation(s)
- Brian H Walsh
- Neonatal Brain Research Group, Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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Hızlı D, Altınbaş ŞK, Köşüş A, Köşüş N, Uysal S, Hacıvelioğlu S, Gelişen O, Kafalı H. Cord blood S100B levels in low-risk term pregnancies with meconium-stained amniotic fluid. J Matern Fetal Neonatal Med 2012; 26:233-6. [DOI: 10.3109/14767058.2012.733754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Massaro AN, Chang T, Kadom N, Tsuchida T, Scafidi J, Glass P, McCarter R, Baumgart S, Vezina G, Nelson KB. Biomarkers of brain injury in neonatal encephalopathy treated with hypothermia. J Pediatr 2012; 161:434-40. [PMID: 22494878 PMCID: PMC3580861 DOI: 10.1016/j.jpeds.2012.02.047] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/30/2012] [Accepted: 02/24/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if early serum S100B and neuron-specific enolase (NSE) levels are associated with neuroradiographic and clinical evidence of brain injury in newborns with encephalopathy. STUDY DESIGN Patients who received therapeutic whole-body hypothermia were prospectively enrolled in this observational study. Serum specimens were collected at 0, 12, 24, and 72 hours of cooling. S100B and NSE levels were measured by enzyme linked immunosorbent assay. Magnetic resonance imaging was performed in surviving infants at 7-10 days of life. Standardized neurologic examination was performed by a child neurologist at 14 days of life. Multiple linear regression analyses were performed to evaluate the association between S100B and NSE levels and unfavorable outcome (death or severe magnetic resonance imaging injury/significant neurologic deficit). Cutoff values were determined by receiver operating curve analysis. RESULTS Newborns with moderate to severe encephalopathy were enrolled (n = 75). Median pH at presentation was 6.9 (range, 6.5-7.35), and median Apgar scores of 1 at 1 minute, 3 at 5 minutes, and 5 at 10 minutes. NSE and S100B levels were higher in patients with unfavorable outcomes across all time points. These results remained statistically significant after controlling for covariables, including encephalopathy grade at presentation, Apgar score at 5 minutes of life, initial pH, and clinical seizures. CONCLUSION Elevated serum S100B and NSE levels measured during hypothermia were associated with neuroradiographic and clinical evidence of brain injury in encephalopathic newborns. These brain-specific proteins may be useful immediate biomarkers of cerebral injury severity.
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Affiliation(s)
- An N. Massaro
- Department of Neonatology, Children’s National Medical Center, Washington, DC
| | - Taeun Chang
- Department of Neurology, Children’s National Medical Center, Washington, DC
| | - Nadja Kadom
- Department of Neuroradiology, Children’s National Medical Center, Washington, DC
| | - Tammy Tsuchida
- Department of Neurology, Children’s National Medical Center, Washington, DC
| | - Joseph Scafidi
- Department of Neurology, Children’s National Medical Center, Washington, DC
| | - Penny Glass
- Department of Psychiatry and Behavioral Sciences, Children’s National Medical Center, Washington, DC
| | - Robert McCarter
- Department of Biostatistics and Informatics, Children’s National Medical Center, Washington, DC
| | - Stephen Baumgart
- Department of Neonatology, Children’s National Medical Center, Washington, DC
| | - Gilbert Vezina
- Department of Neuroradiology, Children’s National Medical Center, Washington, DC
| | - Karin B. Nelson
- Department of Neurology, Children’s National Medical Center, Washington, DC,National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Beharier O, Kahn J, Shusterman E, Sheiner E. S100B - a potential biomarker for early detection of neonatal brain damage following asphyxia. J Matern Fetal Neonatal Med 2012; 25:1523-8. [PMID: 22348227 DOI: 10.3109/14767058.2012.664200] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Birth asphyxia results in a significant percentage of neonatal morbidity and mortality. A key factor in the management of this complication is the early and accurate detection of brain damage following asphyxia. Currently, reliable tools for such diagnosis are absent. Extensive research has focused on biomarkers in an attempt to solve this matter. Recent data marked serum and urine elevation of the S100B protein as an established peripheral biomarker for detection of brain injury including traumatic head injuries and brain damage following cardiac arrest and stroke. In the past decade, a substantial number of studies illustrated the potential use of S100B testing in order to detect brain damage in asphyxiated newborns. This review summarizes the available data regarding the use of S100B as a biomarker of brain damage following birth asphyxia.
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Affiliation(s)
- Ofer Beharier
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Alonso-Alconada D, Alvarez A, Hilario E. Cannabinoid as a neuroprotective strategy in perinatal hypoxic-ischemic injury. Neurosci Bull 2011; 27:275-85. [PMID: 21788999 DOI: 10.1007/s12264-011-1008-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Perinatal hypoxia-ischemia remains the single most important cause of brain injury in the newborn, leading to death or lifelong sequelae. Because of the fact that there is still no specific treatment for perinatal brain lesions due to the complexity of neonatal hypoxic-ischemic pathophysiology, the search of new neuroprotective therapies is of great interest. In this regard, therapeutic possibilities of the endocannabinoid system have grown lately. The endocannabinoid system modulates a wide range of physiological processes in mammals and has demonstrated neuroprotective effects in different paradigms of acute brain injury, acting as a natural neuroprotectant. Concerning perinatal asphyxia, the neuroprotective role of this endogenous system is emerging these years. The present review mainly focused on the current knowledge of the cannabinoids as a new neuroprotective strategy against perinatal hypoxic-ischemic brain injury.
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Affiliation(s)
- Daniel Alonso-Alconada
- Department of Cell Biology and Histology, School of Medicine and Dentistry, University of the Basque Country, Leioa, Vizcaya, Spain
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Costantine MM, Weiner SJ, Rouse DJ, Hirtz DG, Varner MW, Spong CY, Mercer BM, Iams JD, Wapner RJ, Sorokin Y, Thorp JM, Ramin SM, O'Sullivan MJ, Peaceman AM, Simhan HN. Umbilical cord blood biomarkers of neurologic injury and the risk of cerebral palsy or infant death. Int J Dev Neurosci 2011; 29:917-22. [PMID: 21736934 PMCID: PMC3210377 DOI: 10.1016/j.ijdevneu.2011.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 06/20/2011] [Accepted: 06/20/2011] [Indexed: 11/17/2022] Open
Abstract
To evaluate the association between cerebral palsy (CP) or infant death and putative cord blood biomarkers of neurologic injury, we performed a nested case-control secondary analysis of a multicenter randomized trial of magnesium sulfate (MgSO(4)) versus placebo to prevent CP or death among offspring of women with anticipated delivery from 24 to 31 weeks' gestation. Cases were infants who died by 1 year (n=25) or developed CP (n=16), and were matched 1:2 to a control group (n=82) that survived without developing CP. Umbilical cord sera concentrations of S100B, neuron-specific enolase (NSE) and the total soluble form of the receptor for advanced glycation end-products (sRAGE) were measured by ELISA in duplicates. Maternal characteristics were similar between the 2 groups. Cases were born at a lower gestational age (GA) and had lower birth weight compared with controls. There were no differences in concentrations of the three biomarkers and the composite outcome of CP or infant death. However, S100B was higher (median 847.3 vs. 495.7 pg/ml; P=0.03) in infants who had CP and total sRAGE was lower (median 1259.3 vs. 1813.1 pg/ml; P=0.02) in those who died compared with the control group. When corrected for delivery GA and treatment group, both differences lost statistical significance. In conclusion, cord blood S100B level may be associated with CP, but this association was not significant after controlling for GA and MgSO(4) treatment.
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Affiliation(s)
- Maged M Costantine
- Department of Obstetrics and Gynecology at the University of Texas Medical Branch, Galveston, TX, USA.
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29
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Beckstrom AC, Humston EM, Snyder LR, Synovec RE, Juul SE. Application of comprehensive two-dimensional gas chromatography with time-of-flight mass spectrometry method to identify potential biomarkers of perinatal asphyxia in a non-human primate model. J Chromatogr A 2011; 1218:1899-906. [PMID: 21353677 PMCID: PMC3064854 DOI: 10.1016/j.chroma.2011.01.086] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/09/2011] [Accepted: 01/31/2011] [Indexed: 12/19/2022]
Abstract
Perinatal asphyxia is a leading cause of brain injury in infants, occurring in 2-4 per 1000 live births. The clinical response to asphyxia is variable and difficult to predict with current diagnostic tests. Reliable biomarkers are needed to help predict the timing and severity of asphyxia, as well as response to treatment. Two-dimensional gas chromatography-time-of-flight-mass spectrometry (GC×GC-TOFMS) was used herein, in conjunction with chemometric data analysis approaches for metabolomic analysis in order to identify significant metabolites affected by birth asphyxia. Blood was drawn before and after 15 or 18 min of cord occlusion in a Macaca nemestrina model of perinatal asphyxia. Postnatal samples were drawn at 5 min of age (n=20 subjects). Metabolomic profiles of asphyxiated animals were compared to four controls delivered at comparable gestational age. Fifty metabolites with the greatest change pre- to post-asphyxia were identified and quantified. The metabolic profile of post-asphyxia samples showed marked variability compared to the pre-asphyxia samples. Fifteen of the 50 metabolites showed significant elevation in response to asphyxia, ten of which remained significant upon comparison to the control animals. This metabolomic analysis confirmed lactate and creatinine as markers of asphyxia and discovered new metabolites including succinic acid and malate (intermediates in the Krebs cycle) and arachidonic acid (a brain fatty acid and inflammatory marker) as potential biomarkers. GC×GC-TOFMS coupled with chemometric data analysis are useful tools to identify acute biomarkers of brain injury. Further study is needed to correlate these metabolites with severity of disease, and response to treatment.
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Affiliation(s)
| | | | - Laura R. Snyder
- Department of Pathology, University of Washington, Seattle, WA 98195
| | - Robert E. Synovec
- Department of Chemistry, University of Washington, Seattle, WA 98195
| | - Sandra E. Juul
- Department of Pediatrics, University of Washington, Seattle, WA 98195
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Apori AA, Herr AE. Homogeneous immunosubtraction integrated with sample preparation enabled by a microfluidic format. Anal Chem 2011; 83:2691-8. [PMID: 21375345 DOI: 10.1021/ac103219x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Immunosubtraction is a powerful and resource-intensive laboratory medicine assay that reports both protein mobility and binding specificity. To expedite and automate this electrophoretic assay, we report on advances to the electrophoretic immunosubtraction assay by introducing a homogeneous, not heterogeneous, format with integrated sample preparation. To accomplish homogeneous immunosubtraction, a step-decrease in separation matrix pore-size at the head of a polyacrylamide gel electrophoresis (PAGE) separation channel enables "subtraction" of target analyte when capture antibody is present (as the large immune-complex is excluded from PAGE), but no subtraction when capture antibody is absent. Inclusion of sample preparation functionality via small pore size polyacrylamide membranes is also key to automated operation (i.e., sample enrichment, fluorescence sample labeling, and mixing of sample with free capture antibody). Homogeneous sample preparation and assay operation allows on-the-fly, integrated subtraction of one to multiple protein targets and reuse of each device. Optimization of the assay is detailed which allowed for ~95% subtraction of target with 20% non-specific extraction of large species at the optimal antibody-antigen ratio, providing conditions needed for selective target identification. We demonstrate the assay on putative markers of injury and inflammation in cerebrospinal fluid (CSF), an emerging area of diagnostics research, by rapidly reporting protein mobility and binding specificity within the sample matrix. We simultaneously detect S100B and C-reactive protein, suspected biomarkers for traumatic brain injury (TBI), in ~2 min. Lastly, we demonstrate S100B detection (65 nM) in raw human CSF with an estimated lower limit of detection of 3.25 nM, within the clinically relevant concentration range for detecting TBI in CSF. Beyond the novel CSF assay introduced here, a fully automated immunosubtraction assay would impact a spectrum of routine but labor and time-intensive laboratory medicine assays.
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Affiliation(s)
- Akwasi A Apori
- Department of Bioengineering, University of California Berkeley, Berkeley, California 94720, USA
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31
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Douglas-Escobar M, Yang C, Bennett J, Shuster J, Theriaque D, Leibovici A, Kays D, Zheng T, Rossignol C, Shaw G, Weiss MD. A pilot study of novel biomarkers in neonates with hypoxic-ischemic encephalopathy. Pediatr Res 2010; 68:531-6. [PMID: 20736881 PMCID: PMC3851011 DOI: 10.1203/pdr.0b013e3181f85a03] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Severe hypoxic-ischemic encephalopathy (HIE) is a devastating condition that can lead to mortality and long-term disabilities in term newborns. No rapid and reliable laboratory test exists to assess the degree of neuronal injury in these patients. We propose two possible biomarkers: 1) phosphorylated axonal neurofilament heavy chain (pNF-H) protein, one of the major subunits of neurofilaments, found only in axonal cytoskeleton of neurons and 2) Ubiquitin C-terminal hydrolase 1 (UCHL1 protein) that is heavily and specifically concentrated in neuronal perikarya and dendrites. High-serum pNF-H and UCHL1 levels are reported in subarachnoid hemorrhage and traumatic brain injury, suggesting that they are released into blood following neuronal injury. We hypothesized that serum pNF-H and UCHL1 were higher in neonates with moderate-to-severe HIE than in healthy neonates. A time-limited enrollment of 14 consecutive patients with HIE and 14 healthy controls was performed. UCHL1 and pNF-H were correlated with clinical data and brain MRI. UCHL1 and pNF-H serum levels were higher in HIE versus controls. UCHL1 showed correlation with the 10-min Apgar score, and pNF-H showed correlation with abnormal brain MRI. Our findings suggest that serum UCHL1 and pNF-H could be explored as diagnostic and prognostic tools in neonatal HIE.
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Alonso-Alconada D, Alvarez FJ, Alvarez A, Mielgo VE, Goñi-de-Cerio F, Rey-Santano MC, Caballero A, Martinez-Orgado J, Hilario E. The cannabinoid receptor agonist WIN 55,212-2 reduces the initial cerebral damage after hypoxic–ischemic injury in fetal lambs. Brain Res 2010; 1362:150-9. [DOI: 10.1016/j.brainres.2010.09.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 01/09/2023]
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Abstract
Cerebral hypothermia reduces brain injury and improves behavioral recovery after hypoxia-ischemia (HI) at birth. However, using current enrolment criteria many infants are not helped, and conversely, a significant proportion of control infants survive without disability. In order to further improve treatment we need better biomarkers of injury. A 'true' biomarker for the phase of evolving, 'treatable' injury would allow us to identify not only whether infants are at risk of damage, but also whether they are still able to benefit from intervention. Even a less specific measure that allowed either more precise early identification of infants at risk of adverse neurodevelopmental outcome would reduce the variance of outcome of trials, improving trial power while reducing the number of infants unnecessarily treated. Finally, valid short-term surrogates for long term outcome after treatment would allow more rapid completion of preliminary evaluation and thus allow new strategies to be tested more rapidly. Experimental studies have demonstrated that there is a relatively limited 'window of opportunity' for effective treatment (up to about 6-8h after HI, the 'latent phase'), before secondary cell death begins. We critically evaluate the utility of proposed biochemical, electronic monitoring, and imaging biomarkers against this framework. This review highlights the two central limitations of most presently available biomarkers: that they are most precise for infants with severe injury who are already easily identified, and that their correlation is strongest at times well after the latent phase, when injury is no longer 'treatable'. This is an important area for further research.
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Affiliation(s)
- L. Bennet
- Corresponding author. Dr Laura Bennet, Professor, Fetal Physiology and Neuroscience Group Department of Physiology, The University of Auckland, Private Bag 92019 Auckland, New Zealand Tel.: +64 9 373 7599 ext. 84890; fax: +64 9 373 7499. (L. Bennet)
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d'Aloja E, Müller M, Paribello F, Demontis R, Faa A. Neonatal asphyxia and forensic medicine. J Matern Fetal Neonatal Med 2010; 22 Suppl 3:54-6. [PMID: 19757333 DOI: 10.1080/14767050903198397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the last decades, the scientific literature addressing neonatal encephalopathy has grown in a logarithmic way and malpractice claims in obstetrics and neonatology have become a major threat to the health service. At the moment, scientific evidence are insufficient to clearly identify in each single case whether the hypoxic insult has developed in the course of labor or in the first few hours after the birth or, otherwise, whether the damage has to recognize a remote and long-lasting cause acting during pregnancy. Several authors feel that this scientific uncertainty leads to a higher percentage of civil suit decisions prone to recognizing a guilty medical behavior, and they wish a more in-depth analysis of all these cases to clearly identify all the data either in favor or in contrary to the assumption of the existence of a causal correlation between neonatal encephalopathy and medical misbehavior. This article will focus on the medico-legal approach to a hypoxic-ischemic event in the perinatal period, addressing the relevant data to be collected in order to establish the medical and juridical cause of the neonatal damage.
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Affiliation(s)
- E d'Aloja
- Forensic Science Department, Cagliari University, Monserrato, Cagliari, Italy.
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Schmidt H, Gerber J, Stuertz K, Djukic M, Bunkowski S, Fischer FR, Otto M, Nau R. S100B in the cerebrospinal fluid--a marker for glial damage in the rabbit model of pneumococcal meningitis. Neurosci Lett 2010; 475:104-7. [PMID: 20347934 DOI: 10.1016/j.neulet.2010.03.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 03/08/2010] [Accepted: 03/21/2010] [Indexed: 01/13/2023]
Abstract
The rabbit model provides an important experimental setting for the evaluation of antibiotic agents against pneumococcal meningitis. One of the primary targets of this model is the study of neuronal and glial cell damage in bacterial meningitis. The aim of this investigation was to evaluate whether a significant increase of S100B in the cerebrospinal fluid (CSF) as an indicator of white matter damage could be observed in this meningitis model. Seven rabbits were infected intracisternally with S. pneumoniae, and CSF S100B concentrations were examined serially before infection, at 12h, 14h, 17h, 20h, and at 24h after infection. The course of CSF S100B increase and its relation to other parameters of brain tissue destruction and CSF inflammation were measured. Axonal damage was visualized by amyloid precursor protein (APP) immunostaining and demyelination by Luxol Fast Blue/Periodic Acid Schiff (LFB-PAS) stain. In each animal, we observed a distinct rise in S100B concentration in the CSF due to pneumococcal meningitis. We conclude that the CSF concentration of the glial S100B protein can be used as an additional parameter for future interventional studies focusing on glial cell damage in the rabbit model of bacterial meningitis.
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Affiliation(s)
- H Schmidt
- University of Goettingen, Department of Neurology/Department of Medical Psychology and Medical Sociology, Robert-Koch-Str. 40, D-37099 Goettingen, Germany.
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The role of hypoxia-inducible transcription factors in the hypoxic neonatal brain. Brain Dev 2009; 31:503-9. [PMID: 19398180 DOI: 10.1016/j.braindev.2009.03.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 03/10/2009] [Accepted: 03/12/2009] [Indexed: 11/22/2022]
Abstract
Hypoxia-inducible transcription factors (HIF)-1 and HIF-2, composed of an oxygen-dependent alpha-subunit and a constitutive beta-subunit, have been characterized as the most important regulators of oxygen homeostasis during physiological and pathological conditions. During embryonic, fetal and postnatal brain development, HIFs and specific HIF target genes are involved in early and highly active maturational processes by modulating cell differentiation, vascular development, angiogenesis and metabolic homeostasis. Under hypoxic conditions, activation of the HIF system reflects an immediate and cell-specific response to acute brain hypoxia. In a complementary fashion, both HIF-1 and HIF-2 modulate cerebral hypoxic stress responses and activate endogenous neuroprotective systems during acute and late stages of hypoxic/ischemic (HI) damage of the developing brain. Therefore, HIFs and their specific target genes that are expressed during brain injury are of particular interest for future diagnostic and therapeutic options in HI injury of the developing nervous system.
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Schulpis KH, Margeli A, Akalestos A, Vlachos GD, Partsinevelos GA, Papastamataki M, Antsaklis A, Papassotiriou I. Effects of mode of delivery on maternal–neonatal plasma antioxidant status and on protein S100B serum concentrations. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 66:733-42. [PMID: 17101566 DOI: 10.1080/00365510600977737] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the effect of the mode of labour and delivery on total antioxidant status (TAS) and on the protein S100B serum concentrations in mothers and their newborns. MATERIAL AND METHODS Sixty women with normal pregnancies were divided into three groups: Group A (n = 20) with normal labour and vaginal delivery (VG), group B (n = 18) with prolonged labour+VG and group C (n = 22) with scheduled caesarean section (CS). Blood was obtained at the beginning of the labour process and immediately after delivery (pre- and post-delivery) as well as from the umbilical cord (CB). TAS and creatine kinase (CK) were measured using commercial kits. Serum S100B levels were evaluated with the electrochemiluminescence immunoassay "ECLIA" on the ROCHE ELECSYS 2010 immunoassay analyser. RESULTS Post-delivery, TAS levels were significantly decreased in group A and especially in group B. S100B levels were increased in group B (0.0712+/-0.02 microg/L) as compared with those of group A (0.0567+/-0.03 microg/L, p<0.01) and group C (0.038+/-0.03 microg/L, p<0.01), the levels in group C remaining practically unaltered (pre- versus post-delivery). In the newborns, S100B levels were almost 2-fold higher in group B (0.67+/-0.18 microg/L) than those in group A (0.40+/-0.05 microg/L p<0.001) and group C (0.31+/-0.04 microg/L p<0.001). A negative correlation was found between TAS and S100B protein (r = -0.61, p<0.001), the latter positively correlated to CK (r = 0.48, p<0.01). CONCLUSIONS The increased S100B serum levels in the mothers of group B, post-delivery, may have been due to the long-lasting, oxidative and/or psychogenic stress. The observed remarkably high levels of S100B in the group B newborns may have been due to compressive conditions on the foetus brain during this mode of delivery.
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Affiliation(s)
- K H Schulpis
- Institute of Child Health, Research Centre, Athens, Greece
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Balak N, Isiksacan N, Turkoglu R. Does serum osmolarity change as a result of the reflex neuroprotective mechanism of cerebral osmo-regulation after minor head trauma? J Korean Neurosurg Soc 2009; 45:151-6. [PMID: 19352476 DOI: 10.3340/jkns.2009.45.3.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 02/22/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE It is well known that changes in cerebral hemodynamics occur after traumatic brain injury (TBI). Osmo-regulation in the brain is important for maintaining a constant milieu in the central nervous system. Nevertheless, to our knowledge, early osmolarity changes after minor head injury have not been studied until now. METHODS In this study, serum osmolarity was measured in 99 patients with minor head trauma. As a control group, blood samples were drawn from 99 patients who had a minor trauma in an extremity. Serum osmolarity was estimated using a fully automatic biochemical autoanalyzer within the first 3 hours after the trauma. RESULTS The mean serum osmolarity levels were 286.08+/-10.17 mOsm/L in the study group and 290.94+/-5.65 mOsm/L in the control group (p<0.001). However, after age adjustment between the study and control groups, this statistical significance was found to be valid only for patients over 30 years of age. CONCLUSION It was noted that serum osmolarity levels decrease in the first 3 hours following minor head trauma in patients over 30 years of age. Further studies into this area could provide guidance for the management/treatment of elderly patients.
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Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Bakirkoy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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Subbaswamy A, Hsu AA, Weinstein S, Bell MJ. Correlation of cerebral Near-infrared spectroscopy (cNIRS) and neurological markers in critically ill children. Neurocrit Care 2009; 10:129-35. [PMID: 18592418 DOI: 10.1007/s12028-008-9122-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To correlate regional brain saturations (RSO(2)) measured by cerebral Near-infrared spectroscopy (cNIRS) with serological markers indicative of neurological injury (neuron-specific enolase (NSE) and S100beta). METHODS Children with at least one organ failure who were undergoing cNIRS monitoring were eligible for enrollment, while children with hyperbilirubinemia and cyanotic heart disease were excluded. Children were further analyzed based on the presence of an acute neurological injury (defined as hypoxic/ischemic injury after cardiac arrest, status epilepticus, meningitis, encephalopathy) as well as survival. RSO(2) was measured continuously (every 30 s) and averages were obtained at 6 h and 24 h epochs prior to serum collection (E6 and E24, respectively). Serum was collected for NSE and S100beta, which were both determined by ELISA. Serum from children undergoing evaluation for fever in the Emergency department served as serological controls. Correlations were determined using the Pearson Product Moment Correlations. RESULTS A total of 26 children underwent cNIRS monitoring for a total of 47 days. Overall NSE was greater in critically ill children compared to controls, as well as in all subsets of children analyzed (acute CNS injuries, no acute CNS injuries, survivors and non-survivors). S100beta tended to be greater in critically ill children, but this did not reach statistical significance. Average RSO(2) in E6 and E24 was 68.0% +/- 1.5 and 68.6% +/- 1.6, respectively, in a total of 131,036 measurements and E6 RSO(2) was strongly, negatively correlated with S100beta in children with acute neurological injuries. CONCLUSIONS This is the first study to correlate averaged RSO(2) measured by cNIRS with neurological injury markers in critically ill children. We believe that this data can be used to establish thresholds for RSO(2) that can be tested in future trials to determine if this technology is predictive of long-term neurological outcome.
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Affiliation(s)
- Anjali Subbaswamy
- Division of Critical Care Medicine, Children's National Medical Center, Washington, DC 20010, USA
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Ramaswamy V, Horton J, Vandermeer B, Buscemi N, Miller S, Yager J. Systematic review of biomarkers of brain injury in term neonatal encephalopathy. Pediatr Neurol 2009; 40:215-26. [PMID: 19218035 DOI: 10.1016/j.pediatrneurol.2008.09.026] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 08/18/2008] [Accepted: 09/17/2008] [Indexed: 01/13/2023]
Abstract
Although neonatal hypoxic-ischemic encephalopathy is a common cause of childhood developmental disability, its timing, duration, and outcomes are poorly defined. Biomarkers serve as surrogates for disease injury, evolution, and outcome, but no tissue biomarker in routine clinical use can help predict outcomes in term newborn encephalopathy. We reviewed biomarkers in human term neonatal encephalopathy, to determine if current biomarkers are strong enough for clinical use as predictors of outcomes. A comprehensive search of databases identified 110 publications that met our inclusion criteria, i.e., (1) newborns at >36 weeks; (2) neonatal encephalopathy as defined by the American College of Obstetrics and Gynecology; (3) the use of a serum, urine, or cerebrospinal fluid biomarker; and (4) reported outcomes beyond age 12 months. Of those 110 publications, 22 reported outcomes beyond age 12 months. In single reports, urine lactate (P < 0.001), first urine S100 (P < 0.0001), cord-blood interleukin-6 (P = 0.02), serum nonprotein-bound iron (P < 0.001), serum CD14 cell NFkappaB activation (P = 0.014), serum interleukin-8 (P = 0.03), and serum ionized calcium (P = 0.001) were potential predictors of death or abnormal outcomes. A meta-analysis identified serum interleukin-1b (P = 0.04, n = 3), serum interleukin-6 (P = 0.04, n = 2), cerebrospinal fluid neuron-specific enolase (P = 0.03, n = 3), and cerebrospinal fluid interleukin-1b (P = 0.003, n = 2) as putative predictors of abnormal outcomes in survivors, when measured before age 96 hours. Several serum, urine, and cerebrospinal fluid biomarkers of term neonatal encephalopathy may provide important information regarding long-term outcomes. None, however, were studied extensively enough to warrant routine clinical use. Validation of these markers, either alone or in combination, is required in the development of viable therapeutic interventions.
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Affiliation(s)
- Vijay Ramaswamy
- Section of Pediatric Neurosciences, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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Trollmann R, Strasser K, Keller S, Antoniou X, Grenacher B, Ogunshola OO, Dötsch J, Rascher W, Gassmann M. Placental HIFs as markers of cerebral hypoxic distress in fetal mice. Am J Physiol Regul Integr Comp Physiol 2008; 295:R1973-81. [DOI: 10.1152/ajpregu.00053.2008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Reduced oxygen supply during the pre- and perinatal period often leads to acquired neonatal brain damage. So far, there are no reliable markers available to assess the hypoxic cerebral damage and the resulting prognosis during the immediate postnatal period. Thus we aimed to determine whether the hypoxia-inducible transcription factors (HIF-1 and HIF-2) and/or their target genes in the placenta represent reliable indicators of hypoxic distress of the developing brain during systemic hypoxia at the end of gestation. To this end, pregnant mice were exposed to systemic hypoxia (inspired O2 fraction: 6%, 6 h) at gestational day 20. This hypoxic exposure significantly increased HIF-1α and HIF-2α protein levels in brain and placental tissue. Compared with normoxic controls, an increase of HIF-1α-immunoreactive neurons and HIF-2α-positive glial cells and vascular endothelial cells was observed in hypoxic cerebral cortex and hippocampus. In placenta, HIF-1α and HIF-2α were expressed in labyrinthine layer with increased staining intensity during hypoxia compared with normoxia. Significant upregulation of VEGF mRNA and protein in brain and placenta, as well as erythropoietin protein in placenta, indicated activity of the HIF system upon fetal hypoxia. Notably, hypoxia did not affect expression of the HIF target genes inducible nitric oxide synthase and GLUT-1. Taken together, at gestational day 20, systemic hypoxia led to upregulation of HIF-α in mouse brain that was temporally paralleled in placenta, implying that α-subunits of both HIF-1 and HIF-2 are indeed early markers of hypoxic distress in vivo. If our data reflect the situation in humans, analysis of the placenta will allow early identification of the hypoxic brain distress occurring near birth.
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Loukovaara M, Teramo K, Alfthan H, Hämäläinen E, Stefanovic V, Andersson S. Amniotic fluid S100B protein and erythropoietin in pregnancies at risk for fetal hypoxia. Eur J Obstet Gynecol Reprod Biol 2008; 142:115-8. [PMID: 19042077 DOI: 10.1016/j.ejogrb.2008.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 08/29/2008] [Accepted: 10/05/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE S100B protein is a biochemical marker for brain injury, and high serum S100B levels have been observed in newborns with birth asphyxia. We hypothesized that the concentration of amniotic fluid erythropoietin, which increases in chronic fetal hypoxia, correlates with amniotic fluid S100B concentration. STUDY DESIGN Amniotic fluid samples in 35 pregnancies at high risk for chronic fetal hypoxia were obtained at cesarean section or by amniocentesis done within a median of 2 days before delivery. S100B and erythropoietin concentrations were measured by chemiluminescent immunoassays. RESULTS A positive correlation existed between the concentrations of S100B and erythropoietin in the amniotic fluid (r=0.57, p<0.0001). Amniotic fluid S100B concentration was higher (70 ng/l; 33-469, n=17) (median; range) in pregnancies with elevated amniotic fluid erythropoietin (>or= 50 IU/l) than in pregnancies with normal erythropoietin (34 ng/l; 20-340, n=18) (p<0.0001, Mann-Whitney U-test). S100B predicted an elevated amniotic fluid erythropoietin concentration in the study population with the sensitivity of 94% and specificity of 83%. CONCLUSION A strong positive correlation exists between amniotic fluid S100B and erythropoietin concentrations in pregnancies at high risk for chronic fetal hypoxia. This suggests that chronic fetal hypoxia increases the intrauterine release of S100B.
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Affiliation(s)
- Mikko Loukovaara
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
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Stuart A, Edvinsson L, Källen K, Olofsson P, Hellsten C, Amer-Wåhlin I. Fetal electrocardiographic monitoring during labor in relation to cord blood levels of the brain-injury marker protein S-100. J Perinat Med 2008; 36:136-41. [PMID: 18331207 DOI: 10.1515/jpm.2008.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cord artery protein S-100 levels at birth are potential markers of brain damage after asphyxia. Our aim was to investigate if S-100 levels were elevated in neonates with indirect signs of asphyxia during birth. S-100 levels in cord blood were studied in relation to cardiotocography (CTG) and fetal electrocardiography (FECG) changes during birth and to acidemia in umbilical blood. MATERIAL AND METHODS This case-control study was performed in parallel to a large randomized controlled trial (RCT) studying FECG at birth. Protein S-100 samples were collected from 103 neonates at birth and related to the CTG and ECG changes during labor and to pH in umbilical blood. RESULTS Protein S-100 was significantly higher in neonates with umbilical artery blood pH<or=7.05, compared to neonates with pH>7.05. Furthermore, neonates with preterminal CTG patterns showed increased S-100 levels compared to neonates with normal CTG. Neonates having significant CTG and ECG changes, leading to intervention according to clinical guidelines, showed significantly higher S-100 levels compared to neonates without such indication of intervention. CONCLUSION A relation exists between S-100 in umbilical blood at birth, acidosis and pathological patterns in CTG and FECG during labor.
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Affiliation(s)
- Andrea Stuart
- Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden
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Abstract
OBJECTIVE To determine whether known serum markers of neurologic injury are increased in children with septic shock. DESIGN Prospective, observational study. SETTING Tertiary-care, pediatric intensive care unit. PATIENTS Two cohorts of children (n = 24) with septic shock were prospectively enrolled within 24 hrs of their diagnosis. In cohort 1, serum markers (S100beta, neuron-specific enolase [NSE], and glial fibrillary acidic protein [GFAP]) were determined (n = 18). In cohort 2, in addition to serum markers, urine S100beta and GFAP were determined, and continuous electroencephalography (cEEG) was performed. Children who presented to the emergency room with a fever served as controls (n = 32). Children with known neurologic conditions were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Serum and urine were collected daily for up to 7 days or until pediatric intensive care unit discharge. Biomarker concentrations were determined by commercially available enzyme-linked immunosorbent assays. cEEG was performed on days 1, 2, 4, and 7 in a 16-channel montage for at least 6 hrs. Physical examinations did not reveal focal neurologic deficits. Children with septic shock demonstrated increased serum S100beta and NSE compared with controls (mean +/- SEM: 10.5 microg/L +/- 2.4 vs. .9 microg/L +/- .1, p < .001; 96.6 microg/L +/- 8.9 vs. 4.0 microg/L +/- 1.3, p < .001, respectively). Serum GFAP was detectable in five septic children and none of the controls. In cohort 2, urine of four patients demonstrated measurable S100beta levels, and GFAP was detected in one child (nonsurvivor). cEEG demonstrated moderate to severe encephalopathy in all children studied. CONCLUSIONS Markers of neurologic injuries are increased in children with septic shock. This may indicate subclinical injuries that are either transient or permanent. Studies that correlate the long-term neurologic outcome of children with these markers are needed to identify children at risk for neurologic injuries from septic shock.
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Weitzdörfer R, Höger H, Burda G, Pollak A, Lubec G. Differences in Hippocampal Protein Expression at 3 Days, 3 Weeks, and 3 Months Following Induction of Perinatal Asphyxia in the Rat. J Proteome Res 2008; 7:1945-52. [DOI: 10.1021/pr700835y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Rachel Weitzdörfer
- Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18, 1090 Vienna, Austria, and Division for Laboratory Animal Science and Genetics, Medical University of Vienna, Brauhausgasse 34, 2325 Himberg, Austria
| | - Harald Höger
- Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18, 1090 Vienna, Austria, and Division for Laboratory Animal Science and Genetics, Medical University of Vienna, Brauhausgasse 34, 2325 Himberg, Austria
| | - Gudrun Burda
- Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18, 1090 Vienna, Austria, and Division for Laboratory Animal Science and Genetics, Medical University of Vienna, Brauhausgasse 34, 2325 Himberg, Austria
| | - Arnold Pollak
- Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18, 1090 Vienna, Austria, and Division for Laboratory Animal Science and Genetics, Medical University of Vienna, Brauhausgasse 34, 2325 Himberg, Austria
| | - Gert Lubec
- Department of Pediatrics, Medical University of Vienna, Waehringer Guertel 18, 1090 Vienna, Austria, and Division for Laboratory Animal Science and Genetics, Medical University of Vienna, Brauhausgasse 34, 2325 Himberg, Austria
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Murabayashi M, Minato M, Okuhata Y, Makimoto M, Hosono S, Masaoka N, Okada T, Yamamoto T, Mugishima H, Takahashi S, Harada K. Kinetics of serum S100B in newborns with intracranial lesions. Pediatr Int 2008; 50:17-22. [PMID: 18279199 DOI: 10.1111/j.1442-200x.2007.02506.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of the present study was to evaluate the usefulness of serum S100B as a clinical marker of intracranial lesions in newborns. METHODS The study involved 22 normal and 40 diseased newborns. Serum S100B level was measured on days 1 and 6 in normal newborns. Diseased newborns were classified into four groups: birth asphyxia with hypoxic-ischemic encephalopathy (HIE); birth asphyxia without HIE; intracranial hemorrhage (mainly subarachnoid); and brain malformation. In each group the serum S100B level was measured on days 1, 2 and 6. Development was also assessed to investigate the relation between serum S100B level and prognosis at 18 months after birth. RESULTS In normal newborns, serum S100B level was significantly higher in those with liquor to meconium stain than in those without. In diseased newborns, serum S100B level on day 1 was significantly higher in the HIE group than in all other groups (P < 0.05). There was no significant difference in serum S100B level between control and intracranial hemorrhage, or brain malformation. In newborns with birth asphyxia, serum S100B level was significantly higher in severe birth asphyxia than in mild or moderate birth asphyxia; two newborns with serum S100B level > or =10 microg/L on days 1 and 2 developed cerebral palsy, others with no increase of S100B were all developing normally. CONCLUSIONS Serum S100B level is a useful marker of acute perinatal brain damage, and is particularly valuable for fetal distress. In newborns with birth asphyxia, serum S100B levels serve as a biochemical marker of HIE.
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Affiliation(s)
- Masao Murabayashi
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan.
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Okazaki K, Kondo M, Kato M, Kakinuma R, Nishida A, Noda M, Kimura H. Elevation of high-mobility group box 1 concentration in asphyxiated neonates. Neonatology 2008; 94:105-9. [PMID: 18277058 DOI: 10.1159/000116635] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 10/15/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND In asphyxiated neonates, abnormal proinflammatory cytokine/chemokine production may be induced. High-mobility group box 1 (HMGB-1) protein is a new type of proinflammatory cytokine that induces abnormal inflammatory responses involving proinflammatory cytokine production. However, the physiological significance of HMGB-1 in asphyxia is poorly understood. OBJECTIVES We aimed to evaluate whether serum HMGB-1 levels were changed in asphyxia by measuring the serum concentration of HMGB-1 in both asphyxiated and normally delivered neonates at birth. METHODS Using enzyme-linked immunosorbent assay, we measured the concentration of HMGB-1 in sera obtained from 53 asphyxiated neonates and 32 normally delivered neonates immediately after birth. RESULTS The serum concentrations of HMGB-1 in asphyxiated neonates were significantly higher than those in normally delivered neonates without asphyxia (p = 0.033). CONCLUSION We suggest that the elevation of HMGB-1 might be associated with abnormal inflammatory responses involving the excessive production of proinflammatory cytokines in neonates with asphyxia.
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Affiliation(s)
- Kaoru Okazaki
- Tokyo Metropolitan Hachioji Children's Hospital, Tokyo, Japan.
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Isobe-Harima Y, Terai S, Segawa M, Uchida K, Yamasaki T, Sakaida I. Serum S100b (astrocyte-specific protein) is a useful marker of hepatic encephalopathy in patients with fulminant hepatitis. Liver Int 2008; 28:146-7. [PMID: 18173564 DOI: 10.1111/j.1478-3231.2007.01604.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Zaramella P, Saraceni E, Freato F, Falcon E, Suppiej A, Milan A, Laverda AM, Chiandetti L. Can tissue oxygenation index (TOI) and cotside neurophysiological variables predict outcome in depressed/asphyxiated newborn infants? Early Hum Dev 2007; 83:483-9. [PMID: 17052867 DOI: 10.1016/j.earlhumdev.2006.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/28/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Diagnostic tools of birth asphyxia provide only an uncertain prediction of neurological outcome. AIMS To assess whether TOI and DeltaCBV, combined with a set of biochemical and neurophysiological variables, have any diagnostic and prognostic value in birth depression or asphyxia. STUDY DESIGN Case control study at the nursery and NICU of the Padova University Children's Hospital. SUBJECTS 22 term neonates with an Apgar score < or = 6 at 5', a 1-h umbilical artery pH value < or = 7.25 with an increased base deficit and a gestational age > or = 36 weeks; 15 healthy term infants with an Apgar score > or = 9 at 5'. OUTCOME MEASURES Troponin I and NIRS measurements (TOI and DeltaCBV) were assessed in both groups. Blood gases, neurological evaluation, US, NIRS, EEG and SEP were evaluated in the infants with depression or asphyxia. RESULTS Troponin I was higher in the study group than in controls (p=0.04), showing a correlation with base excess values. In the depressed/asphyxiated neonates with an abnormal outcome at 1 year, TOI rose to 80.1% vs 66.4% in controls (p=0.04) and 74.7% in infants with a normal 1-year outcome. A multiple regression model showed a significant multiple correlation coefficient, R=0.79, p<0.001, where the predictive variables significantly associated with outcome were SEP and BE. CONCLUSIONS Troponin I is a useful short-term index of birth asphyxia or perinatal depression. An increased TOI suggests a risk of abnormal neurological outcome at 1 year. Among the cotside variables, BE and evoked potential abnormalities were the best predictors of abnormal outcome in this study.
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Affiliation(s)
- Patrizia Zaramella
- Department of Paediatrics, Neonatal Intensive Care Unit, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy.
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Friel LA, Romero R, Edwin S, Nien JK, Gomez R, Chaiworapongsa T, Kusanovic JP, Tolosa JE, Hassan SS, Espinoza J. The calcium binding protein, S100B, is increased in the amniotic fluid of women with intra-amniotic infection/inflammation and preterm labor with intact or ruptured membranes. J Perinat Med 2007; 35:385-93. [PMID: 17624933 PMCID: PMC2587429 DOI: 10.1515/jpm.2007.101] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE S100B is produced by glia of the central and peripheral nervous systems and is considered a marker of neurologic injury in the perinatal period. Indeed, increased neonatal urine S100B concentration is associated with adverse neurological outcomes including intraventricular hemorrhage and hypoxic-ischemic encephalopathy, while elevated adult serum concentrations are associated with infectious diseases/sepsis. The objective of this study was to determine whether amniotic fluid (AF) S100B concentrations change with advancing gestational age and intra-amniotic infection (IAI). STUDY DESIGN S100B concentration was measured in the AF of women in midtrimester, at term, and in pregnancies with preterm labor and intact membranes (PTL) or preterm premature rupture of membranes (PPROM), with and without IAI. Placental pathology was performed and neonatal outcomes were analyzed. RESULTS (1) AF S100B concentration did not change during gestation; (2) patients with IAI had significantly higher AF S100B concentration than those without IAI following an episode of PTL or PPROM and; (3) neonates who had morbidity/mortality had had an elevated AF S100B concentration; however, this could be explained by the association with intra-amniotic infection/inflammation. Thus, AF S100B concentration was not an independent predictor of neonatal morbidity or fetal/neonatal death. CONCLUSIONS An elevated concentration of AF S100B may reflect intra-amniotic infection/inflammation and not necessarily fetal neurologic damage.
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Affiliation(s)
- Lara A. Friel
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Corresponding authors: Lara A. Friel, MD/PhD and Roberto Romero, MD, Perinatology Research Branch, Division of Intramural Research, National Institute of Child Health and Human Development, NIH, 4 Brush South/Hutzel Women's Hospital 3990 John R, Detroit, MI, 48201, Phone: (313) 993−2700, Fax: (313) 993−2694, E-mail:
| | - Roberto Romero
- The Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- The Center for Molecular Medicine and Genetics at Wayne State University, Detroit, Michigan, USA
- Corresponding authors: Lara A. Friel, MD/PhD and Roberto Romero, MD, Perinatology Research Branch, Division of Intramural Research, National Institute of Child Health and Human Development, NIH, 4 Brush South/Hutzel Women's Hospital 3990 John R, Detroit, MI, 48201, Phone: (313) 993−2700, Fax: (313) 993−2694, E-mail:
| | - Sam Edwin
- The Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Jyh Kae Nien
- The Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Ricardo Gomez
- Sotero del Rio Hospital, Center for Perinatal Diagnosis and Research, Santiago, Chile
| | - Tinnakorn Chaiworapongsa
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- The Perinatology Research Branch, National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Jorge E. Tolosa
- Pennsylvania Hospital, Philadelphia, PA, and Oregon Health and Science University, Portland, Oregon, USA
| | - Sonia S. Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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