Analysis of Brain Injury Biomarker Neurofilament Light and Neurodevelopmental Outcomes and Retinopathy of Prematurity Among Preterm Infants

Abstract

Key Points Question How do serum levels of the brain injury biomarkers neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) change after preterm birth, and are these biomarkers associated with neonatal morbidities? Findings In this cohort study of 221 infants born preterm, infants experienced a postnatal increase in NfL that continued for at least 1 month after birth. High serum levels of NfL were associated with the retinal neurovascular disease retinopathy of prematurity (ROP) and, in an exploratory analysis, associated with an unfavorable neurodevelopmental outcome at 2 years of age. Meaning These findings suggest that serum levels of the neuronal injury biomarker NfL might be used as an early clinical biomarker of ROP development and neurodevelopmental outcome; however, this should be investigated further.

Neurofilaments contribution in clinic: state of the art

“…Recent research has focused on the determination of NfL values in children , and norms could be proposed in the pediatric population (Nitz et al, 2021 ). Increased NfL is described to be correlated with the development of motor neurological disorders or retinopathy in premature infants (Goeral et al, 2021 ; Sjöbom et al, 2021 ). The value of NfL in CSF and blood also appears to be associated with the severity of inherited diseases with neurological impairment, such as SMA (Johannsen et al, 2021 ; Nitz et al, 2021 ), cerebral adrenoleukodystrophy (Wang et al, 2022 ) or mitochondrial diseases (Sofou et al, 2019 ).…”

No increase in GFAP and S-100B in very preterm infants with mild periventricular leukomalacia or intraventricular hemorrhage: a pilot study

“…A large three-cohort study on 221 preterm infants found a median cord blood GFAP level of 261.4 (range 104.1-2433.7) ng/L on day 1 after birth. The longitudinal levels of GFAP did not indicate any distinctive pattern in relation to GA, morbidities, or other clinical variables, including the presence of IVH ( 25 ). A lower reference median serum GFAP value of 0.91 ± 1.019 ng/L was recently determined in 64 healthy preterm infants ( 26 ).…”

Vaginal Delivery Is Associated with Neurochemical Evidence of Increased Neuroaxonal Remodelling in Infants from the KUNO-Kids Health Study: Cross-Sectional Analysis

“…However, as the cohort was relatively small, an influence on cognitive outcome can by no means be ruled out [8]. In fact, it appears that the key to clinically predictive relevance lies in the individual dynamics of NfL rather than in absolute values [14].…”

“…We also found higher NfL levels in the first week of life in brain-damaged infants [8]. Further studies have shown that serum NfL dynamics in early life predict neurodevelopmental outcome in preterm infants with and without intraventricular hemorrhage [13, 14]. We conducted this study to test the hypothesis that cord blood NfL levels reflect the mode of delivery, to explore additional potential predictors of NfL at birth, and to establish a large database of NfL values in healthy neonates for future studies with sick neonates of all kinds, including, e.g., perinatal hypoxic-ischemic encephalopathy, perinatal stroke, and congenital infections.…”