Abstract
To investigate whether cerebrospinal fluid levels of neuron-specific enolase (CSF-NSE) during the first 72 hours correlate with other tools used to assess ongoing brain damage, including clinical grading of hypoxic-ischemic encephalopathy (HIE), abnormal patterns in amplitude integrated electroencephalography (aEEG), and magnetic resonance imaging (MRI), as well as with the neurodevelopmental outcomes at two years of age. Prospective observational study performed in two hospitals between 2009 and 2011. Forty-three infants diagnosed with HIE within 6 hours of life were included. HIE was severe in 20 infants, moderate in 12, and mild in 11. Infants with moderate-to-severe HIE received whole-body cooling. Both the HIE cohort and a control group of 59 infants with suspected infection underwent measurement of CSF-NSE concentrations at between 12 and 72 hours after birth. aEEG monitoring was started at admission and brain MRI was performed within the first 2 weeks. Neurodevelopment was assessed at 24 months. The HIE group showed higher levels of CSF-NSE than the control group: median 70 ng/ml (29; 205) vs 10.6 ng/ml (7.7; 12.9); p <0.001. Median levels of CSF-NSE in infants with severe, moderate, and mild HIE were 220.5 ng/ml (120.5; 368.8), 45.5 ng/ml (26, 75.3), and 26 ng/ml (18, 33), respectively. CSF-NSE levels correlated were significantly higher in infants with seizures, abnormal aEEG, or abnormal MRI, compared to those without abnormalities. Infants with an adverse outcome showed higher CSF-NSE levels than those with normal findings (p<0.001), and the most accurate CSF-NSE cutoff level for predicting adverse outcome in the whole cohort was 108 ng/ml and 50ng/ml in surviving infants. In the era of hypothermia, CSF-NSE concentrations provides valuable information as a clinical surrogate of the severity of hypoxic-ischemic brain damage, and this information may be predictive of abnormal outcome at two years of age.
Highlights
Despite the advent of therapeutic hypothermia (TH) as the sole specific intervention shown to improve neurodevelopmental outcomes, hypoxic-ischemic encephalopathy (HIE) continues to contribute to major worldwide perinatal mortality and to long-term disability in full-term and near-term newborns [1, 2].Early and accurate assessment of the severity of brain damage after a perinatal hypoxic– ischemic event remains one of the most difficult challenges in neonatal care
cerebrospinal fluid levels of neuron-specific enolase (CSF-Neuron specific enolase (NSE)) levels correlated were significantly higher in infants with seizures, abnormal amplitude integrated electroencephalography (aEEG), or abnormal Moderate-severe injury (MRI), compared to those without abnormalities
In the era of hypothermia, cerebrospinal fluid (CSF)-NSE concentrations provides valuable information as a clinical surrogate of the severity of hypoxic-ischemic brain damage, and this information may be predictive of abnormal outcome at two years of age
Summary
Despite the advent of therapeutic hypothermia (TH) as the sole specific intervention shown to improve neurodevelopmental outcomes, hypoxic-ischemic encephalopathy (HIE) continues to contribute to major worldwide perinatal mortality and to long-term disability in full-term and near-term newborns [1, 2]. And accurate assessment of the severity of brain damage after a perinatal hypoxic– ischemic event remains one of the most difficult challenges in neonatal care. Current methods of assessing the risk of brain injury in the newborn have inherent limitations during the first hours of life, and uncertainty regarding the severity of ongoing brain damage and eventual neurological outcome persists during this early period [8, 9]. A biochemical index of brain injury would be highly desirable to increase the reliability of predictions of neurological sequelae after hypoxic-ischaemic brain injury. Several central nervous system-specific molecules have been investigated in blood serum and in cerebrospinal fluid (CSF) as possible quantitative indexes of perinatal brain injury [10,11,12,13,14]
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