title: Glial fibrillary acidic protein as a biomarker for brain injury in neonatal CHD.
abstract: Neonates with critical CHD have evidence, by imaging, of preoperative brain injury, although the timing is unknown. We used circulating postnatal serum glial fibrillary acidic protein as a measure of acute perinatal brain injury in neonates with CHD. Glial fibrillary acidic protein was measured on admission and daily for the first 4 days of life in case and control groups; we included two control groups in this study - non-brain-injured newborns and brain-injured newborns. Comparisons were performed using the Kruskal-Wallis test with Dunn's multiple comparisons, Student's t-test, and χ2 test of independence where appropriate. In aggregate, there were no significant differences in overall glial fibrillary acidic protein levels between CHD patients (n=56) and negative controls (n=23) at any time point. By day 4 of life, 7/56 (12.5%) CHD versus 0/23 (0%) normal controls had detectable glial fibrillary acidic protein levels. Although not statistically significant, the 5/10 (50%) left heart obstruction group versus 1/17 (6%) conoventricular, 0/13 (0%) right heart, and 1/6 (17%) septal defect patients trended towards elevated levels of glial fibrillary acidic protein at day 4 of life. Overall, glial fibrillary acidic protein reflected no evidence for significant peripartum brain injury in neonates with CHD, but there was a trend for elevation by postnatal day 4 in neonates with left heart obstruction. This pilot study suggests that methods such as monitoring glial fibrillary acidic protein levels may provide new tools to optimise preoperative care and neuroprotection in high-risk neonates with specific types of CHD.
authors.affiliation: 1Department of Pediatrics,Division of Neonatology,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: McKenney
authors.affiliation: 2Department of Pediatrics,Division of Pediatric Cardiology,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Fahad F
authors.initials: FF
authors.lastname: Mansouri
authors.affiliation: 2Department of Pediatrics,Division of Pediatric Cardiology,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Everett
authors.affiliation: 3Department of Gynecology and Obstetrics,Division of Maternal-Fetal Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Ernest M
authors.initials: EM
authors.lastname: Graham
authors.affiliation: 3Department of Gynecology and Obstetrics,Division of Maternal-Fetal Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Irina
authors.initials: I
authors.lastname: Burd
authors.affiliation: 2Department of Pediatrics,Division of Pediatric Cardiology,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Priya
authors.initials: P
authors.lastname: Sekar
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010865:Pilot Projects; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein
keywords: CHD; Glial fibrillary acidic protein; neurological injury