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Serum CK-BB activity in the preterm infant and outcome at two and four years of age
L den Ouden1, M van de Bor, F van Bel
1Department of Clinical Chemistry, University Hospital of Leiden, The Netherlands.
Insights
Elevated serum creatine kinase brain-specific isoenzyme (CK-BB) after birth may indicate potential for delayed mental development in preterm infants. Further research is needed, particularly for infants experiencing asphyxia.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Biochemistry
Background:
- Premature infants face risks of neurodevelopmental challenges.
- Serum creatine kinase brain-specific isoenzyme (CK-BB) is a marker of brain injury.
- Predicting neurodevelopmental outcomes in preterm infants is crucial.
Purpose of the Study:
- To investigate the association between early postnatal serum CK-BB levels and neurodevelopmental outcomes at 2 and 4 years corrected age in preterm infants.
- To determine if serum CK-BB activity predicts motor disabilities or cognitive development.
- To explore the potential of CK-BB as a biomarker for adverse neurodevelopment in this population.
Main Methods:
- Prospective study of 45 preterm infants (<34 weeks gestation).
- Serum CK-BB activity measured immediately after birth.
- Neurodevelopmental assessment using Bayley Scales of Mental Development and evaluation for motor disabilities at 2 and 4 years corrected age.
- Follow-up of 35 surviving infants.
Main Results:
- No significant relationship found between serum CK-BB activity and motor disabilities (diplegia, hemiplegia).
- A trend suggested a link between higher serum CK-BB and lower mental development scores, but it lacked statistical significance.
- Four out of five infants with high postnatal CK-BB (>25U/L) required special schooling due to mental retardation by age four.
Conclusions:
- Elevated postnatal serum CK-BB activity may be associated with delayed mental development in preterm infants.
- Serum CK-BB is not a reliable predictor of motor disabilities in this cohort.
- Further investigation, especially in asphyxiated preterm infants, is warranted to confirm the association with cognitive outcomes.
Abstract:
The relationship between serum creatine kinase brain-specific isoenzyme (CK-BB) activity immediately after birth and neurodevelopmental outcome at two and four years corrected age was studied prospectively in 45 preterm infants (less than 34 weeks gestation). Nine infants died during the neonatal period and one was lost to follow-up. Of the 35 children available for follow-up, seven had motor disabilities: four severe diplegia, two mild to moderate diplegia and one hemiplegia. No relationship existed between these motor disabilities and serum CK-BB activity after birth. There seemed to be a relationship between increased serum CK-BB after birth and low scores on the Bayley Scales of Mental Development, but this did not reach statistical significance. At the age of four years, four of the five survivors with high serum CK-BB activity after birth (greater than 25U/L) needed special schooling because of mental retardation. Increased serum CK-BB activity after birth may be associated with delayed mental development, but further study is needed, especially of asphyxiated infants.