Serum glial fibrillary acidic protein as a biomarker of brain injury in premature neonates

Abstract

Neonatal brain injury is a serious adverse outcome of prematurity. Early detection of high risk premature neonates to develop neonatal brain injury is not currently feasible. The predictive value of many biomarkers has been tested, but none is used currently in clinical practice. The purpose of this study was to determine the levels and predictive value of serum glial fibrillary acidic protein (GFAP) in a prospective longitudinal case-control study during the first three days of life in premature neonates (<34 weeks of gestation) that later developed either intraventricular hemorrhage or periventricular leukomalacia. Each case (n=29) was matched according to birth weight and gestational age to one neonate with normal head ultrasound scans. No significant difference on GFAP levels was observed between the groups. Nevertheless, neonates with brain injury presented more frequently GFAP levels above the lowest detection limit (0.056 ng/ml) and this trend was significantly different during all days. The effectiveness of GFAP as an early biomarker of neonatal brain injury in premature neonates seems to be limited.

Effect of maternal serum magnesium and calcium levels on umbilical glial fibrillary acidic protein levels in preterm labor

“…GFAP is a specific protein released by the brain, especially astrocytes, in response to trauma, so its value is expected to increase in brain injury and remain low in the absence of brain injury 23 – 26 . Table 3 explains that in the group given magnesium sulfate, there were 28 samples below the reagent detection limit issued by the factory that issued the reagent, which was below 0.045 ng/l.…”

“…The administration of magnesium as a neuroprotector aims to increase serum magnesium levels in the umbilical cord blood, which will also affect calcium levels in the umbilical cord. Massive neuroprotective therapy and prolonged duration of administration were correlated with depression of serum calcium levels 26 – 30 . Several studies also stated that there was no significant relationship between calcium levels and the incidence of hypoxemic-ischemic encephalopathy.…”

“…It appears to have a similar competitive function in blocking intracellular Ca 2+ channels, decreasing calcium availability, and preventing smooth muscle contractility. In addition, magnesium also competes with calcium at the motor endplate, decreasing excitation by preventing the excess release of acetylcholine 26 , 38 . In this study, the relationship between maternal magnesium, maternal calcium, and umbilical cord GFAP levels did not provide a significant difference.…”

Serum Activin A as Brain Injury Biomarker in the First Three Days of Life. A Prospective Case—Control Longitudinal Study in Human Premature Neonates

“…The present study is part of a wider research protocol on the levels and predictive values of NBI biomarkers in PNs [22,23]. The methods of the research study have been previously published [22] and are summarized here as follows:…”

Serum Neuron-Specific Enolase as a Biomarker of Neonatal Brain Injury—New Perspectives for the Identification of Preterm Neonates at High Risk for Severe Intraventricular Hemorrhage

“…NSE is involved in glycolysis, a metabolic pathway that generates energy in the form of adenosine triphosphate (ATP) within cells. In neurons, NSE plays a crucial role in energy production, and it is often used as a marker to identify and measure neuronal or neuroendocrine cell damage or injury [18,19]. Therefore, measuring the levels of NSE in the blood can be a valuable tool in clinical settings.…”