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Prognostic value of creatine kinase BB-isoenzyme in high risk newborn infants
1Children's Hospital, University of Helsinki, Finland.
Insights
Serum creatine kinase BB-isoenzyme (CK-BB) activity measured at birth predicts neonatal death in infants. However, elevated CK-BB levels do not predict neurological damage in surviving infants.
Area of Science:
- Neonatal Medicine
- Biochemistry
- Neurology
Background:
- Serum creatine kinase BB-isoenzyme (CK-BB) is an enzyme relevant to brain tissue.
- Investigating CK-BB as a biomarker in high-risk newborns is crucial for understanding neonatal outcomes.
Purpose of the Study:
- To assess the predictive value of early-life serum CK-BB activity for neonatal mortality and long-term neurodevelopmental outcomes.
- To correlate CK-BB levels with hypoxic-ischaemic brain injury, cerebral palsy, and other developmental impairments.
Main Methods:
- Serum CK-BB activity was measured on the first day of life in infants experiencing acute asphyxia, high-risk pregnancies, or very low birth weight.
- Neurodevelopmental evaluations were conducted at 2.2-2.5 years of age.
- Statistical analysis compared CK-BB levels between infants with different outcomes, including death, brain injury, cerebral palsy, and normal development.
Main Results:
- Infants who died with hypoxic-ischaemic brain lesions had significantly higher CK-BB activity compared to those with normal outcomes.
- CK-BB levels in infants who later developed cerebral palsy or mild motor impairment were similar to control groups.
- Elevated CK-BB activity at birth was predictive of neonatal death but not of neurological damage in surviving infants.
Conclusions:
- Early serum CK-BB activity is a significant predictor of neonatal mortality.
- CK-BB levels are not a reliable predictor of neurological sequelae, such as cerebral palsy, in surviving infants.
- Further research may explore other biomarkers for predicting neurological damage in high-risk newborns.
Abstract:
Serum creatine kinase BB-isoenzyme (CK-BB) activity was studied on the first day of life in 31 acutely asphyxiated infants, 70 infants born after high risk pregnancies (pre-eclampsia or intrauterine growth retardation, or both), and 47 very low birthweight infants. Neuro-developmental evaluation was carried out at 2.2-2.5 years. Eight infants died with, and eight without, hypoxic-ischaemic lesions of the brain, 14 had cerebral palsy, 16 had mild motor impairment, six had developmental delay without motor impairment, and 96 were normal at follow up. Infants who died with brain injury had significantly higher CK-BB activity than infants with normal outcomes (geometric mean 12 U/l); the mean difference was 82 U/l with a 95% confidence interval from 31 to 219 U/l. CK-BB in infants with cerebral palsy and mild motor impairment (geometric means 12 and 15 U/l, respectively) were similar to controls. CK-BB activity after birth is predictive of neonatal death but not of neurological damage in survivors.