title: Glial fibrillary acidic protein as a biomarker for periventricular white matter injury.
abstract: OBJECTIVE
  Periventricular white matter injury (PWMI), a precursor of cerebral palsy, traditionally is not diagnosed until 6 weeks of life by head ultrasound scanning. We sought to determine whether early neonatal glial fibrillary acidic protein (GFAP) levels could identify PWMI in low birthweight (<2500 g) infants.
  
  
  METHODS
  Each case with PWMI on head ultrasound scanning at 6 weeks of life from April 2009 to April 2011 was matched by gestational age and mode of delivery to 2 subsequent neonates with a normal head ultrasound scan. GFAP was measured in cord blood at birth, at neonatal intensive care unit admission, and on days 1-4 of life.
  
  
  RESULTS
  During this 2-year period, 21 cases with PWMI with gestational age 27.4 ± 3.3 weeks were compared with 42 control infants. The incidence of cesarean delivery was 61.9% in both groups. GFAP was not significantly different in cord blood or at neonatal intensive care unit admission but was significantly elevated on day 1 (median, 5-95%; 0, 0-0.98 ng/mL cases; 0, 0-0.06 ng/mL control infants; P = .03), day 2 (0, 0-1.21 ng/mL; 0, 0-0.05 ng/mL, respectively; P = .02), day 3 (0.05, 0-0.33 ng/mL; 0, 0-0.04 ng/mL, respectively; P = .004), and day 4 (0.02, 0-1.03 ng/mL; 0, 0-0.05 ng/mL, respectively; P < .001). The odds of the development of PWMI significantly increased with increasing levels of GFAP from day 1-4 of life when adjustment was made for preeclampsia, antenatal steroid administration, and neonatal chronic lung disease.
  
  
  CONCLUSIONS
  The ability to predict PWMI with a blood test for GFAP shortly after birth opens the possibility for rapid identification of infants for early intervention and provides a benchmark for the qualification of new therapies to improve neurodevelopmental outcomes.
authors: Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD.
authors: Amanda
authors: A
authors: Stewart
authors: Aylin
authors: A
authors: Tekes
authors: Thierry A G M
authors: TA
authors: Huisman
authors: Jacky M
authors: JM
authors: Jennings
authors: Marilee C
authors: MC
authors: Allen
authors: Frances J
authors: FJ
authors: Northington
authors: Allen D
authors: AD
authors: Everett
authors: Ernest M
authors: EM
authors: Graham
mesh_terms: D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000097:blood* / Q000000981:diagnostic imaging; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000378:metabolism*; D005260:Female; D005865:Gestational Age; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D007230:Infant, Low Birth Weight / Q000097:blood* / Q000378:metabolism; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000097:blood / Q000000981:diagnostic imaging; D007969:Leukomalacia, Periventricular / Q000097:blood* / Q000000981:diagnostic imaging; D016014:Linear Models; D008297:Male; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein
keywords: cerebral palsy; glial fibrillary acidic protein; periventricular white matter injury