Brain-specific proteins in the cerebrospinal fluid of severely asphyxiated newborn infants.
Upcoming trials of neuroprotective strategies in severely asphyxiated newborn infants emphasize the need for early and objective markers of both good and bad long-term prognosis. Traditional markers such as neurological depression and seizures are not specific.


OBJECTIVE
To study whether measurement in the cerebrospinal fluid of some proteins known to be specific to the central nervous system was in covariance with the clinical course and long-term prognosis.


METHODS
Twenty-two asphyxiated infants were included in the study and compared with a control group of 8 infants without signs of perinatal asphyxia. Cerebrospinal fluid (CSF) was collected during the first 4 d of life and analysed for neurofilament protein (NFp), glial fibrillary acidic protein (GFAp), protein S-100 and neuron-specific enolase (NSE).


RESULTS
The concentrations of all four proteins were significantly increased in the CSF of asphyxiated infants. The concentrations correlated significantly with other indicators of long-term prognosis and to neurological impairment at I y of age, or death before that time. Specifically, concentrations were excessively high in the five infants who died.


CONCLUSIONS
High concentrations of brain-specific proteins are released into the CSF of asphyxiated infants. It might therefore be useful to measure these concentrations when excluding patients with the gravest prognosis from neuroprotective trials.
Blennow
M
M
Department of Paediatrics, Huddinge University Hospital and Neonatal Programme, Astrid Lindgren's Children's Hospital, Karolinska Institutet, Stockholm, Sweden. mats.blennow@kbh.ki.se
Sävman
K
K
Ilves
P
P
Thoresen
M
M
Rosengren
L
L
D001238:Asphyxia Neonatorum / Q000134:cerebrospinal fluid*; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid*; D006801:Humans; D007231:Infant, Newborn; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid*; D010751:Phosphopyruvate Hydratase / Q000134:cerebrospinal fluid*; D009418:S100 Proteins / Q000134:cerebrospinal fluid*; D012720:Severity of Illness Index
D005904:Glial Fibrillary Acidic Protein; D016900:Neurofilament Proteins; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase