Biomarkers for hypoxic ischemic encephalopathy

Abstract

With the advent of therapeutic hypothermia as an effective treatment for hypoxic ischemic encephalopathy associated with birth, the identification of which infants will benefit has become a research priority. Similarly, if investigators could identify the infants likely to have poor outcomes soon after birth, then additional promising therapies could be targeted to these infants at highest risk. In this issue of The Journal, Chalak et al report that glial fibrillary acidic protein, a protein specific to astrocytes, and ubiquitin carboxyl-terminal hydrolase L 1, a protein concentrated in dendrites, were elevated in cord blood plasma. Their levels correlated with neurologic outcomes at 15-18 months of age for a small group of infants treated with hypothermia. They also found that rewarming did not alter the levels of these proteins or selected cytokines. In an accompanying editorial, Ferriero and Bonifacio emphasize the complexity of the pathophysiology of neonatal brain injury and the difficulty to identify useful biomarkers to date. Productive studies to identify and validate biomarkers will need to be multicentered to have sufficient patient numbers for careful phenotyping of the infants with magnetic resonance imaging and 2-year outcomes. Article page 468▶ Editorial page 438▶ Biomarkers for Severity of Neonatal Hypoxic-Ischemic Encephalopathy and Outcomes in Newborns Receiving Hypothermia TherapyThe Journal of PediatricsVol. 164Issue 3PreviewTo evaluate serum neuronal and inflammatory biomarkers to determine whether measurements of umbilical cords at birth can stratify severity of hypoxic-ischemic encephalopathy (HIE), whether serial measurements differ with hypothermia-rewarming, and whether biomarkers correlate with neurological outcomes. Full-Text PDF The Search Continues for the Elusive Biomarkers of Neonatal Brain InjuryThe Journal of PediatricsVol. 164Issue 3PreviewMany studies have attempted to discover “biomarkers” in the setting of hypoxic-ischemic encephalopathy (HIE) in an effort to identify infants at risk for brain injury. A recent meta-analysis showed that none of the more than 100 published studies investigating various blood, urine, and cerebrospinal fluid markers, was conducted in a sufficiently rigorous manner to allow recommendation of such biomarkers for routine clinical use.1 The problem stems in part from the lack of independent validation cohorts in these studies. Full-Text PDF