Biomarkers for brain injury from neonatal encephalopathy

Abstract

Neonatal encephalopathy following birth is generally associated with an identifiable antenatal event. Although the infant with encephalopathy can be identified by the need for and responses to resuscitative efforts and clinical neurologic state in the hours following birth, the prognosis depends on how the clinical findings progress or resolve over days. But time is precious because hypothermia, the only proven therapy to improve the outcome, should be started with 6 hours of birth and shorter intervals between birth and the start of hypothermia are preferable. After an infant is receiving hypothermia, the prognosis remains unknown until the therapy has been completed and the neurologic status and the magnetic resonance imaging (MRI) have been evaluated.In this issue of The Journal, Massaro et al report that two biomarkers measured at initiation of hypothermia and during the course of the therapy correlated well with MRI findings at 7-10 days and a neurologic exam at 14 days. The proteins S100B and neuron-specific enolase were elevated in plasma for infants with poor outcomes at the start of hypothermia and throughout the 72 hours of hypothermia. S100B is released by injured astrocytes and neuron-specific enolase indicates neural injury. These biomarker proteins also are elevated following brain injuries in other types of patients. The challenge is to develop a clinical strategy to identify infants who will benefit from hypothermia versus those who will not, either because their prognosis is good without hypothermia or is bad even with hypothermia. These biomarkers might help identify the latter group for participation in studies to augment the benefits of hypothermia.Article page 434▶ Neonatal encephalopathy following birth is generally associated with an identifiable antenatal event. Although the infant with encephalopathy can be identified by the need for and responses to resuscitative efforts and clinical neurologic state in the hours following birth, the prognosis depends on how the clinical findings progress or resolve over days. But time is precious because hypothermia, the only proven therapy to improve the outcome, should be started with 6 hours of birth and shorter intervals between birth and the start of hypothermia are preferable. After an infant is receiving hypothermia, the prognosis remains unknown until the therapy has been completed and the neurologic status and the magnetic resonance imaging (MRI) have been evaluated. In this issue of The Journal, Massaro et al report that two biomarkers measured at initiation of hypothermia and during the course of the therapy correlated well with MRI findings at 7-10 days and a neurologic exam at 14 days. The proteins S100B and neuron-specific enolase were elevated in plasma for infants with poor outcomes at the start of hypothermia and throughout the 72 hours of hypothermia. S100B is released by injured astrocytes and neuron-specific enolase indicates neural injury. These biomarker proteins also are elevated following brain injuries in other types of patients. The challenge is to develop a clinical strategy to identify infants who will benefit from hypothermia versus those who will not, either because their prognosis is good without hypothermia or is bad even with hypothermia. These biomarkers might help identify the latter group for participation in studies to augment the benefits of hypothermia. Article page 434▶ Biomarkers of Brain Injury in Neonatal Encephalopathy Treated with HypothermiaThe Journal of PediatricsVol. 161Issue 3PreviewTo determine if early serum S100B and neuron-specific enolase (NSE) levels are associated with neuroradiographic and clinical evidence of brain injury in newborns with encephalopathy. Full-Text PDF