New biomarkers of fetal-neonatal hypoxic stress.
The complex pathophysiological mechanisms underlying perinatal hypoxia make it difficult to define early markers of severe hypoxia-ischemia encephalopathy. However, as progress in the development of neuroprotective therapeutic measures continues, the early identification of neonates at risk of severe hypoxic-ischemic encephalopathy is an important goal for appropriate decision making. Although the timing of perinatal hypoxic brain damage may vary and is sometimes unknown, high levels of non-protein-bound iron and high nucleated red blood cell counts in cord blood indicate an antepartum origin of neurological impairment, because they can occur only as a consequence of a pre-existing asphyxic event.


CONCLUSIONS
The combined assessment of nucleated red blood cells and non-protein-bound iron at birth seems extremely useful for the early identification of newborns at high risk of brain damage. Activin A also seems to be a reliable marker of perinatal hypoxia. Prospective long-term follow-up studies are needed to verify their predictive role.
Perrone
S
S
Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
Bracci
R
R
Buonocore
G
G
D028341:Activins / Q000032:analysis*; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D004912:Erythrocytes / Q000502:physiology*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005609:Free Radicals / Q000097:blood; D006801:Humans; D019271:Hypoxanthine / Q000032:analysis*; D007231:Infant, Newborn; D028322:Inhibin-beta Subunits / Q000032:analysis*; D007501:Iron / Q000009:adverse effects / Q000378:metabolism*; D008297:Male; D018384:Oxidative Stress; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers; D005609:Free Radicals; C422405:activin A; D028341:Activins; D019271:Hypoxanthine; D028322:Inhibin-beta Subunits; D007501:Iron