Abstract
Introduction: Surfactant proteins (SP) have been shown to be inherent proteins of the human CNS and are altered during acute and chronic disturbances of CSF circulation. Aim of the study was to examine the changes of surfactant protein concentrations in CSF of preterm babies suffering from intraventricular hemorrhage.Patients and Methods: Consecutive CSF samples of 21 preterm infants with intraventricular hemorrhages (IVH) and posthemorrhagic hydrocephalus (PHHC) were collected at primary intervention, after 5–10 days and at time of shunt insertion ~50 days after hemorrhage. Samples were analyzed for surfactant proteins A, B, C, and G by ELISA assays and the results were compared to 35 hydrocephalus patients (HC) without hemorrhage and 6 newborn control patients.Results and Discussion: Premature patients with IVH showed a significant elevation of surfactant proteins SP-A, C, and G compared to HC and control groups: mean values for the respective groups were SP-A 4.19 vs. 1.08 vs. 0.38 ng/ml. Mean SP-C 3.63 vs. 1.47 vs. 0.48 ng/ml. Mean SP-G 3.86 vs. 0.17 vs. 0.2 ng/ml. SP-A and G concentrations were slowly falling over time without reaching normal values. SP-C levels declined faster following neurosurgical interventions and reached levels comparable to those of hydrocephalus patients without hemorrhage.Conclusion: Intraventricular hemorrhages of premature infants cause posthemorrhagic CSF flow disturbance and are associated with highly significant elevations of surfactant proteins A, C, and G independent of total CSF protein concentrations.
Highlights
Surfactant proteins (SP) have been shown to be inherent proteins of the human CNS and are altered during acute and chronic disturbances of cerebrospinal fluid (CSF) circulation
Our recent studies focusing on embryology and concerning the CNS surfactant system in hydrocephalic conditions suggest a relationship between surfactant protein concentrations and intraventricular hemorrhage [6]
The aim of this study was the examination of potential alterations of surfactant protein concentrations within the CSF of neonates suffering from intraventricular hemorrhage resulting in posthemorrhagic hydrocephalus (PHHC)
Summary
Surfactant proteins (SP) have been shown to be inherent proteins of the human CNS and are altered during acute and chronic disturbances of CSF circulation. SP-B and SP-D showed a marked delay in occurrence of immunoreactivities at the brain-CSF and blood-brain-interfaces compared to lung tissue of the same animal [1]. Both surfactant proteins appear only in adult rat brains, whereas SP-A and SP-C can already be found in embryologic stages. Rheologically active SP-B may play a role in an incompetent reduction of surface tension within the pulsating brain: Resulting higher shear forces may lead to rupture of vulnerable vascular structures within the ependymal zones of the germinal matrix, leading to hemorrhage in similarity to premature lung pathology [7]. Because the influence of breathing on cerebral pulsation seems to exceed the arterial pulsation, postpartum adaptation may explain the higher incidence of IVH within the 1st days after birth compared to the incidence of prenatal hemorrhages
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