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Elevated concentrations of inflammation-related proteins in postnatal blood predict severe developmental delay at 2
T Michael O'Shea1, Elizabeth N Allred, Karl C K Kuban
1Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. moshea@wfubmc.edu
Insights
Elevated inflammation markers in early blood samples of extremely preterm infants predict later mental and motor development issues. Sustained high levels, particularly on day 14, show stronger associations with impaired development.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Inflammation Biology
Background:
- Extremely preterm infants face significant risks for neurodevelopmental impairments.
- Early life inflammation is a suspected contributor to adverse neurodevelopmental outcomes.
- Biomarkers for predicting these outcomes are crucial for timely intervention.
Purpose of the Study:
- To investigate whether elevated inflammation-related proteins in early postnatal blood predict impaired mental and motor development in extremely preterm infants.
- To identify specific proteins and time points in early postnatal life that are most predictive of developmental deficits.
- To establish the association between sustained inflammation and neurodevelopmental outcomes.
Main Methods:
- Blood samples were collected from 939 infants born before 28 weeks gestation on postnatal days 1, 7, and 14.
- Concentrations of 25 inflammation-related proteins were measured.
- Developmental outcomes were assessed at 24 months using the Bayley Scales of Infant Development, Second Edition, with impaired development defined as scores <55 on the Mental or Motor Scale.
Main Results:
- Statistically significant associations (P<.01) were found between elevated levels of 17 of the 25 measured proteins and developmental impairment.
- Elevations present on multiple postnatal days were more strongly associated with impairment than single-day elevations.
- The highest number of predictive protein elevations were observed in blood collected on postnatal day 14.
Conclusions:
- Elevated levels of inflammation-related proteins in extremely preterm infants are associated with impaired mental and motor development at 2 years of age.
- Postnatal days 7 and 14 are key time points for assessing inflammation-related predictive markers.
- Sustained elevations in these proteins indicate a higher risk for neurodevelopmental deficits, highlighting the importance of monitoring and managing inflammation in this vulnerable population.
Objective:
To evaluate the hypothesis that elevated levels of inflammation-related proteins in early postnatal blood predict impaired mental and motor development in extremely preterm infants.
Study Design:
We measured concentrations of 25 inflammation-related proteins in blood collected on postnatal days 1, 7, and 14 from 939 infants born before 28 weeks gestation. An elevated level was defined as a concentration in the highest quartile for gestational age and day of blood collection. We identified impaired development at age 24 months using the Bayley Scales of Infant Development, Second Edition. The primary outcomes were scores on the Mental Scale or the Motor Scale of <55 (more than 3 SDs below the mean).
Results:
For 17 of the 25 inflammation-related proteins, 1 or more statistically significant associations (P<.01) was found between an elevated blood level of the protein and a developmental impairment. Elevations on multiple days were more often associated with developmental impairment than were elevations present for only 1 day. The highest number of predictive elevations was found in day-14 blood.
Conclusion:
In extremely preterm infants, elevated levels of inflammation-related proteins in blood collected on postnatal days 7 and 14, especially when sustained, are associated with impaired mental and motor development at age 2 years.
