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Intermittent hypoxemia in preterm infants: Glial fibrillary acidic protein as a potential brain injury biomarker
EElie G Abu Jawdeh1, Linda J Van Eldik2, Xiao Xu3
1Department of Pediatrics, UT Southwestern Medical Center, and Children's Medical Center of Dallas, Dallas, TX, United States.
Respiratory Physiology & Neurobiology
|June 30, 2026
Summary
Intermittent hypoxemia (IH) in preterm infants is linked to brain injury. This study found that urinary glial fibrillary acidic protein (GFAP) levels increase with greater IH exposure, suggesting GFAP is a biomarker for brain injury.
Area of Science:
- Neonatal research
- Biomarker discovery
- Neuroprotection
Background:
- Intermittent hypoxemia (IH) is common in preterm infants and associated with adverse outcomes.
- Previous research linked IH to S100B, a brain injury biomarker.
- This study investigates the relationship between IH and glial fibrillary acidic protein (GFAP), a marker of astrocyte injury.
Purpose of the Study:
- To assess the association between intermittent hypoxemia (IH) metrics and urinary glial fibrillary acidic protein (GFAP) concentrations in preterm infants.
- To determine if GFAP can serve as a noninvasive biomarker for IH-related brain injury in this population.
Main Methods:
- Prospective enrollment of preterm infants (≤32 weeks' gestation).
- Continuous oxygen saturation monitoring and quantification of IH metrics.
- Measurement of urinary GFAP concentrations using an ultrasensitive immunoassay.
- Weighted Spearman correlation analyses to examine associations between IH and GFAP.
Main Results:
- Higher urinary GFAP concentrations correlated with increased IH burden, including duration, frequency, and severity (p <0.001).
- Extremely preterm infants showed associations between GFAP and both short and long IH events.
- Very preterm infants demonstrated associations primarily with longer IH events.
Conclusions:
- Urinary GFAP levels rise with increased intermittent hypoxemia exposure in preterm infants.
- GFAP, along with S100B, may serve as astroglial biomarkers for IH-related brain injury.
- GFAP offers a potential noninvasive tool for early detection of brain injury in vulnerable preterm infants.
