title: Cerebrospinal fluid obstruction and malabsorption in human neonatal hydrocephaly.
abstract: BACKGROUND
  The pathophysiology involved in human neonatal high-pressure hydrocephalus (HC) includes both cerebrospinal fluid (CSF) malabsorption and obstruction.
  
  
  OBJECTIVE
  The aim was to estimate the relative contribution between CSF malabsorption and obstruction in three different etiological groups of neonatal high-pressure HC by assessment of specific CSF biomarkers indicative of growth factor- and fibrosis-related CSF malabsorption (transforming growth factor beta-1 (TGF beta-1), aminoterminal propeptide of type 1 collagen (PC1NP)].
  
  
  METHODS
  Patients were subdivided into three groups. Group A: spina bifida HC (n=12); group B: non-haemorrhagic triventricular HC (n=4); and group C: posthaemorrhagic HC (n=6). To exclude for confounding differences in pro-inflammatory state between the three groups, interleukin-6 (IL-6) CSF concentrations were assessed. Consecutively, the CSF concentrations of TGF beta-1 and PC1NP were compared between the different groups.
  
  
  RESULTS
  Median CSF concentrations of IL-6 were low and did not differ between groups. Median CSF concentrations of PC1NP were significantly lower in group A (median: 180 ng/ml, range 90-808) than in group C (median: 1,060, range 396-1194; p=0.002). TGF beta-1 concentrations were significantly higher in group C (median 355 pg/ml, range 129-843) than in groups A (median 103, range 78-675 pg/ml) and B (median 120 pg/ml, range 91-188; p=0.01 and 0.03, respectively).
  
  
  CONCLUSIONS
  In neonatal posthaemorrhagic HC, high concentrations of malabsorption-related biomarkers contrast with lower concentrations in SB and non-haemorrhagic triventricular HC. During the early development of high pressure HC in SB neonates, CSF biomarkers strongly indicate that CSF obstruction contributes more to the development of HC than malabsorption.
authors.affiliation: Department of Neonatology, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany. axel.heep@ukb.uni-bonn.de
authors.forename: Axel
authors.initials: A
authors.lastname: Heep
authors.forename: Peter
authors.initials: P
authors.lastname: Bartmann
authors.forename: Birgit
authors.initials: B
authors.lastname: Stoffel-Wagner
authors.forename: Arie
authors.initials: A
authors.lastname: Bos
authors.forename: Eelco
authors.initials: E
authors.lastname: Hoving
authors.forename: Oebele
authors.initials: O
authors.lastname: Brouwer
authors.forename: Albert
authors.initials: A
authors.lastname: Teelken
authors.forename: Carlo
authors.initials: C
authors.lastname: Schaller
authors.forename: Deborah
authors.initials: D
authors.lastname: Sival
mesh_terms: D024042:Collagen Type I / Q000134:cerebrospinal fluid; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005326:Fetal Proteins / Q000134:cerebrospinal fluid; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000134:cerebrospinal fluid*; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D008297:Male; D010446:Peptide Fragments; D011347:Procollagen; D012189:Retrospective Studies; D053773:Transforming Growth Factor beta1 / Q000134:cerebrospinal fluid
chemical_list: D024042:Collagen Type I; D005326:Fetal Proteins; D015850:Interleukin-6; D010446:Peptide Fragments; D011347:Procollagen; D053773:Transforming Growth Factor beta1; C047202:procollagen Type I N-terminal peptide