Abstract
BackgroundNeonatal death in full-term infants who suffer from perinatal asphyxia (PA) is a major subject of investigation, since few tools exist to predict patients at risk of ominous outcome. We studied the possibility that urine S100B measurement may identify which PA-affected infants are at risk of early postnatal death.Methodology/Principal FindingsIn a cross-sectional study between January 1, 2001 and December 1, 2006 we measured S100B protein in urine collected from term infants (n = 132), 60 of whom suffered PA. According to their outcome at 7 days, infants with PA were subsequently classified either as asphyxiated infants complicated by hypoxic ischemic encephalopathy with no ominous outcome (HIE Group; n = 48), or as newborns who died within the first post-natal week (Ominous Outcome Group; n = 12). Routine laboratory variables, cerebral ultrasound, neurological patterns and urine concentrations of S100B protein were determined at first urination and after 24, 48 and 96 hours. The severity of illness in the first 24 hours after birth was measured using the Score for Neonatal Acute Physiology-Perinatal Extension (SNAP-PE). Urine S100B levels were higher from the first urination in the ominous outcome group than in healthy or HIE Groups (p<0.001 for all), and progressively increased. Multiple logistic regression analysis showed a significant correlation between S100B concentrations and the occurrence of neonatal death. At a cut-off >1.0 µg/L S100B had a sensitivity/specificity of 100% for predicting neonatal death.Conclusions/SignificanceIncreased S100B protein urine levels in term newborns suffering PA seem to suggest a higher risk of neonatal death for these infants.
Highlights
Neonatal death in full-term infants suffering perinatal asphyxia (PA) is a major subject of concern, since to date no clinical, biochemical or biophysical tools exist to predict which patients are at risk of ominous outcome [1]
Of the 12 infants with ominous outcome, 10 developed severe hypoxic ischemic encephalopathy (HIE) whilst, in the group complicated by PA with no ominous outcome (HIE group), 36 out of 48 developed mild HIE and 12 out of 48 severe HIE
The present study provides evidence that early after a severe hypoxic insult there is an increase in urine concentrations of S100B, a brain constituent, and that such an increase only occurs in asphyxiated infants who will have a poor neonatal outcome, i.e. neonatal death within 7 postnatal days
Summary
Neonatal death in full-term infants suffering perinatal asphyxia (PA) is a major subject of concern, since to date no clinical, biochemical or biophysical tools exist to predict which patients are at risk of ominous outcome [1]. The possibility of detecting infants at risk of this severe complication is limited since clinical, laboratory and standard monitoring procedures may be silent or unreliable. A practical and sensitive marker able to offer neonatologists a useful tool for clinical and ethical purposes is eagerly awaited. Neonatal death in full-term infants who suffer from perinatal asphyxia (PA) is a major subject of investigation, since few tools exist to predict patients at risk of ominous outcome. We studied the possibility that urine S100B measurement may identify which PA-affected infants are at risk of early postnatal death
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