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Perioperative Glial Fibrillary Acidic Protein Is Associated with Long-Term Neurodevelopment Outcome of Infants with
Michela Vergine1, Luca Vedovelli2, Manuela Simonato3
1Division of Pediatrics, Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy.
Insights
Glial fibrillary acidic protein (GFAP) shows promise as an early indicator of neurodevelopmental issues in infants undergoing heart surgery. Elevated GFAP levels may predict long-term cognitive and psychopathological impairments following cardiopulmonary bypass.
Area of Science:
- Biomarkers in pediatric cardiology
- Neurodevelopmental outcomes in congenital heart disease
Background:
- Infants with congenital heart disease (CHD) often experience brain injury and impaired maturation.
- Long-term neurodevelopmental disorders are a significant concern for these children post-surgery.
Purpose of the Study:
- To evaluate plasma glial fibrillary acidic protein (GFAP) as a predictive marker for neurodevelopmental anomalies.
- To assess GFAP's utility in infants with CHD undergoing cardiopulmonary bypass (CPB) surgery.
Main Methods:
- Plasma GFAP levels were measured in 38 infants during various CPB phases.
- Neurodevelopmental functioning was assessed years after surgery using cognitive, neuropsychological, and psychopathological evaluations.
- Non-supervised feature selection and nested non-linear logistic regression were employed to analyze data.
Main Results:
- While 84% of children had normal IQ scores, 58% exhibited an abnormal neurodevelopmental index (NDI), particularly in psychopathology.
- The peak plasma GFAP level was 0.95 ng/mL and correlated with surgical variables.
- A GFAP peak of 0.49 ng/mL was associated with an increased risk of impaired NDI, independent of other clinical factors.
Conclusions:
- Plasma GFAP is a potential early biomarker for predicting long-term neuropsychological development in infants with CHD.
- This finding could lead to earlier interventions for at-risk children.
Background:
Brain injury, impaired brain maturation, and long-term neurodevelopmental disorders are common in infants with congenital heart diseases (CHD). We aimed to assess whether plasma glial fibrillary acidic protein (GFAP) can predict neurodevelopmental anomalies in CHD infants operated on cardiopulmonary bypass (CPB).
Methods:
We measured plasma GFAP in 38 infants at multiple CPB phases. Cognitive, neuropsychological, and psychopathological functioning were assessed 5.7 ± 2.2 years after surgery. We identified an impaired global neurodevelopmental index (NDI) when at least two domains were abnormal. The relationships between NDI, GFAP, and clinical variables were explored with non-supervised feature selection methods and modeled with a nested non-linear logistic regression.
Results:
Intelligence quotient scores were within the normal range in 84% of children, whereas 58% showed an abnormal NDI, with the greatest impairments in the psychopathological area. The plasma GFAP peak was 0.95 (0.44-1.57) ng/mL, and it was correlated with age, weight, duration of surgery phases, and CPB minimum temperature. In the regression model, the GFAP peak was associated with an impaired NDI with a possible flexible point toward NDI impairment at 0.49 ng/mL, keeping constant ICU stay, CPB duration, CHD anatomy, weight, and CPB minimum temperature.
Conclusion:
GFAP is a promising early marker of abnormal long-term neuropsychological development.
