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Updated: Jul 24, 2026

Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury

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Published on: May 27, 2022

Poor Correlation Between Inflammatory and Brain Injury Biomarkers After Neonatal Intraventricular Hemorrhage: A Pilot

Ankit Agarwal¹, Miriam Zamorano², Aidan Collier³

¹Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas, USA.

World Neurosurgery

|June 15, 2025

Summary

Cerebrospinal fluid (CSF) hemoglobin levels did not correlate with neuroinflammatory markers tumor necrosis factor-alpha (TNF-α) or glial fibrillary acidic protein (GFAP) in preterm neonates with intraventricular hemorrhage (IVH). Further research is needed to understand these biomarkers.

Keywords:

Cerebrospinal fluid Glial fibrillary acidic protein Hemoglobin Intraventricular hemorrhage Preterm Tumor necrosis factor-alpha

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Area of Science:

Neonatal Neurology
Neurocritical Care
Pediatric Neurosurgery

Background:

Intraventricular hemorrhage (IVH) is a common complication in preterm neonates.
Cerebrospinal fluid (CSF) diversion is a management strategy for IVH.
Neuroinflammatory and brain injury biomarkers are crucial for understanding IVH progression.

Purpose of the Study:

To investigate changes in hemoglobin, tumor necrosis factor-alpha (TNF-α), and glial fibrillary acidic protein (GFAP) in early CSF diversion stages in preterm neonates with IVH.
To test the hypothesis that higher CSF hemoglobin levels correlate with elevated TNF-α and GFAP.

Main Methods:

Prospective study of preterm infants with grade 3 or 4 IVH undergoing ventricular reservoir placement.
CSF samples collected during reservoir placement and subsequent clinically indicated CSF withdrawals.
Enzyme-linked immunosorbent assays (ELISAs) used to measure biomarker concentrations.

Main Results:

Eight preterm infants (median postmenstrual age 26.3 weeks) were included.
No significant correlation found between CSF hemoglobin, TNF-α, and GFAP levels during early CSF diversion.
An initial significant correlation between GFAP and hemoglobin was not sustained with repeated measures analysis.

Conclusions:

No significant association between CSF hemoglobin and key neuroinflammatory/brain injury biomarkers in early IVH management.
High variability in biomarker levels observed, necessitating further investigation.
Highlights the need for research into the clinical utility and long-term implications of these biomarkers in neonatal IVH.