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Published on: September 6, 2017
Biomarkers of brain injury in the premature infant
Martha Douglas-Escobar1, Michael D Weiss
1Department of Pediatrics, University of Florida Gainesville, FL, USA ; McKnight Brain Institute, University of Florida Gainesville, FL, USA.
Insights
Biomarkers like S100β and Activin show promise for identifying brain injury in premature infants. Identifying these biomarkers aids in monitoring injury progression and assessing neuroprotective treatments.
Area of Science:
- Neonatal neurology
- Biomarker discovery
- Neuroprotection
Background:
- Encephalopathy of prematurity involves acute brain injury and long-term developmental disturbances.
- Intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) are common in preterm infants, with IVH affecting up to 45% of very low birth weight neonates.
- Hypoxic-ischemic injury impacts nearly 60% of very low birth weight newborns, leading to frequent neurodevelopmental disabilities.
Purpose of the Study:
- To review biomarkers for detecting and monitoring brain injury in premature infants.
- To identify biomarkers for assessing the efficacy of neuroprotective strategies.
- To explore biomarkers for conditions like IVH, post-hemorrhagic ventricular dilation (PHVD), and PVL.
Main Methods:
- Review of existing literature on biomarkers in preterm infants with brain injury.
- Examination of specific biomarkers including S100b, Activin A, erythropoietin, CCL 18, GFAP, and NFL.
- Analysis of cerebrospinal fluid biomarkers for predicting shunt requirement in PHVD.
Main Results:
- S100β and Activin are identified as promising biomarkers for IVH.
- TGF-β1, MMP-9, and PAI-1 in cerebrospinal fluid may help predict the need for shunting after PHVD.
- The study highlights the need for clinical validation of both established and novel biomarkers.
Conclusions:
- Effective biomarkers are crucial for managing neonatal brain injury in preterm infants.
- Early identification and monitoring of brain injury can improve neurodevelopmental outcomes.
- Further research and clinical validation of biomarkers are essential for advancing neonatal intensive care.
Abstract:
The term "encephalopathy of prematurity" encompasses not only the acute brain injury [such as intraventricular hemorrhage (IVH)] but also complex disturbance on the infant's subsequent brain development. In premature infants, the most frequent recognized source of brain injury is IVH and periventricular leukomalacia (PVL). Furthermore 20-25% infants with birth weigh less than 1,500 g will have IVH and that proportion increases to 45% if the birth weight is less than 500-750 g. In addition, nearly 60% of very low birth weight newborns will have hypoxic-ischemic injury. Therefore permanent lifetime neurodevelopmental disabilities are frequent in premature infants. Innovative approach to prevent or decrease brain injury in preterm infants requires discovery of biomarkers able to discriminate infants at risk for injury, monitor the progression of the injury, and assess efficacy of neuroprotective clinical trials. In this article, we will review biomarkers studied in premature infants with IVH, Post-hemorrhagic ventricular dilation (PHVD), and PVL including: S100b, Activin A, erythropoietin, chemokine CCL 18, GFAP, and NFL will also be examined. Some of the most promising biomarkers for IVH are S100β and Activin. The concentrations of TGF-β1, MMP-9, and PAI-1 in cerebrospinal fluid could be used to discriminate patients that will require shunt after PHVD. Neonatal brain injury is frequent in premature infants admitted to the neonatal intensive care and we hope to contribute to the awareness and interest in clinical validation of established as well as novel neonatal brain injury biomarkers.
