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Published on: October 28, 2022
Isoprostanes as Biomarker for White Matter Injury in Extremely Preterm Infants
Caterina Coviello1, Serafina Perrone2, Giuseppe Buonocore3
1Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
Insights
Early plasma F2-isoprostanes (IPs) can identify preterm infants at risk for white matter injury (WMI) at term equivalent age. This biomarker shows potential for early detection of brain injury in vulnerable newborns.
Area of Science:
- Neonatal Neurology
- Biomarkers
- Neurodevelopmental Pediatrics
Background:
- Preterm white matter is susceptible to injury from lipid peroxidation.
- F2-isoprostanes (IPs) are established biomarkers of lipid peroxidation.
- Early detection of brain injury in preterm infants is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between early peri-postnatal F2-isoprostanes (IPs) and white matter injury (WMI) in preterm infants.
- To evaluate the predictive value of IPs for WMI at term equivalent age (TEA).
- To assess the relationship between IPs, WMI, and neurodevelopmental outcomes at 24 months corrected age (CA).
Main Methods:
- Inclusion of preterm infants (gestational age < 28 weeks) with MRI at TEA.
- Measurement of IPs in cord blood (cb) and plasma (pl) within 48 hours post-birth.
- Assessment of WMI using the Woodward MRI scoring system and neurodevelopment using BSID-III scores.
- Statistical analysis including multiple regression and Receiver Operating Characteristic (ROC) curve analysis.
Main Results:
- Higher plasma IPs and lower gestational age were significant predictors of higher WMI scores at TEA (p=0.037 and p=0.006).
- Cord blood IPs did not correlate with WMI.
- ROC analysis indicated plasma IPs could discriminate WMI with 86% sensitivity and 60% specificity at a threshold of 31.8 pg/ml (AUC=0.72).
- IPs were not associated with neurodevelopmental outcomes at 24 months CA.
Conclusions:
- Early plasma F2-isoprostane measurement shows promise as an early biomarker for identifying white matter injury in preterm infants.
- This biomarker may help discriminate infants with abnormal WMI scores at term equivalent age, enabling earlier identification of brain injury risk.
- Further research is needed to explore the long-term neurodevelopmental implications.
Abstract:
Background and Aim: Preterm white matter is vulnerable to lipid peroxidation-mediated injury. F2-isoprostanes (IPs), are a useful biomarker for lipid peroxidation. Aim was to assess the association between early peri-postnatal IPs, white matter injury (WMI) at term equivalent age (TEA), and neurodevelopmental outcome in preterm infants. Methods: Infants with a gestational age (GA) below 28 weeks who had an MRI at TEA were included. IPs were measured in cord blood (cb) at birth and on plasma (pl) between 24 and 48 h after birth. WMI was assessed using Woodward MRI scoring system. Multiple regression analyses were performed to assess the association between IPs with WMI and then with BSITD-III scores at 24 months corrected age (CA). Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of pl-IPs for the development of WMI. Results: Forty-four patients were included. cb-IPs were not correlated with WMI score at TEA, whereas higher pl-IPs and lower GA predicted higher WMI score (p = 0.037 and 0.006, respectively) after controlling for GA, FiO2 at sampling and severity of IVH. The area under the curve was 0.72 (CI 95% = 0.51-0.92). The pl-IPs levels plotted curve indicated that 31.8 pg/ml had the best predictive threshold with a sensitivity of 86% and a specificity of 60%, to discriminate newborns with any WMI from newborns without WMI. IPs were not associated with outcome at 24 months. Conclusion: Early measurement of pl-IPs may help discriminate patients showing abnormal WMI score at TEA, thus representing an early biomarker to identify newborns at risk for brain injury.
