Carlos Mario Echeverría-Palacio1, Thais Agut2, Juan Arnaez3, Ana Valls4, Mar Reyne2, Alfredo Garcia-Alix5. 1. Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain; Research Group "Neuroped-UNAL", School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia. 2. Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain. 3. Department of Neonatology, Hospital Universitario de Burgos, Burgos, Spain; Fundación NeNe, Spain. 4. Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain. 5. Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBERER. U724, Madrid, Spain; Fundación NeNe, Spain. Electronic address: agarciaalix@sjdhospitalbarcelona.org.
Abstract
BACKGROUND: Biomarkers of brain injury with high predictive value in newborns in critical neurological status are increasingly required. Neuron-specific enolase in cerebrospinal fluid has been shown to be highly predictive in newborns with perinatal hypoxic-ischemic encephalopathy, but its utility has not been examined in sudden unexpected postnatal collapse. PURPOSE: We analyzed whether the levels of neuron-specific enolase in cerebrospinal fluid can be a useful biomarker to estimate the severity of brain injury in neonates after a sudden unexpected postnatal collapse. METHODS: This is a prospective observational study of near-term infants who were consecutively admitted with sudden unexpected postnatal collapse in two neonatal intensive care units during a nine-year period. Variables were collected and analyzed regarding the perinatal period, clinical course, severity of encephalopathy, amplitude-integrated encephalography, magnetic resonance imaging findings, and outcome. Neuron-specific enolase in cerebrospinal fluid samples were obtained in 18 infants with sudden unexpected postnatal collapse between 12 and 72 hours after the collapse and compared with those of 29 controls. RESULTS: The levels of neuron-specific enolase in cerebrospinal fluid were higher in patients than in controls (P < 0.001). Levels of neuron-specific enolase in cerebrospinal fluid in infants with sudden unexpected postnatal collapse were significantly higher in patients who presented severe encephalopathy, seizures, abnormal amplitude-integrated encephalography background, or brain injury on magnetic resonance imaging. Receiver operator characteristic curve analysis revealed a neuron-specific enolase in cerebrospinal fluid cutoff value of maximum predictive accuracy of 61 ng/mL (area under the curve, 1.0; sensitivity, specificity, positive predictive value, and negative predictive value, 100%) for identifying infants who died or had adverse outcomes. CONCLUSIONS: Levels of neuron-specific enolase in cerebrospinal fluid obtained between 12 and 72 hours after a sudden unexpected postnatal collapse event seem to be a useful biomarker for identifying newborns with severe brain injury and for predicting outcome.
BACKGROUND: Biomarkers of brain injury with high predictive value in newborns in critical neurological status are increasingly required. Neuron-specific enolase in cerebrospinal fluid has been shown to be highly predictive in newborns with perinatal hypoxic-ischemic encephalopathy, but its utility has not been examined in sudden unexpected postnatal collapse. PURPOSE: We analyzed whether the levels of neuron-specific enolase in cerebrospinal fluid can be a useful biomarker to estimate the severity of brain injury in neonates after a sudden unexpected postnatal collapse. METHODS: This is a prospective observational study of near-term infants who were consecutively admitted with sudden unexpected postnatal collapse in two neonatal intensive care units during a nine-year period. Variables were collected and analyzed regarding the perinatal period, clinical course, severity of encephalopathy, amplitude-integrated encephalography, magnetic resonance imaging findings, and outcome. Neuron-specific enolase in cerebrospinal fluid samples were obtained in 18 infants with sudden unexpected postnatal collapse between 12 and 72 hours after the collapse and compared with those of 29 controls. RESULTS: The levels of neuron-specific enolase in cerebrospinal fluid were higher in patients than in controls (P < 0.001). Levels of neuron-specific enolase in cerebrospinal fluid in infants with sudden unexpected postnatal collapse were significantly higher in patients who presented severe encephalopathy, seizures, abnormal amplitude-integrated encephalography background, or brain injury on magnetic resonance imaging. Receiver operator characteristic curve analysis revealed a neuron-specific enolase in cerebrospinal fluid cutoff value of maximum predictive accuracy of 61 ng/mL (area under the curve, 1.0; sensitivity, specificity, positive predictive value, and negative predictive value, 100%) for identifying infants who died or had adverse outcomes. CONCLUSIONS: Levels of neuron-specific enolase in cerebrospinal fluid obtained between 12 and 72 hours after a sudden unexpected postnatal collapse event seem to be a useful biomarker for identifying newborns with severe brain injury and for predicting outcome.
Authors: Seung Ha Son; In Ho Lee; Jung Soo Park; In Sool Yoo; Seung Whan Kim; Jin Woong Lee; Seung Ryu; Yeonho You; Jin Hong Min; Yong Chul Cho; Won Joon Jeong; Se Kwang Oh; Sung Uk Cho; Hong Joon Ahn; Changshin Kang; Dong Hun Lee; Byung Kook Lee; Chun Song Youn Journal: J Clin Med Date: 2020-03-10 Impact factor: 4.241