Neurone-specific enolase and CK-BB in newborn infants with hypoxic-ischemic encephalopathy after birth asphyxia

الملخص EN

Background : The direct assessment of neurologically adverse effects in newborn infants by means of markers in peripheral blood is of great significance.

First, knowledge of neurological damage could be helpful after serious compromising events to decide whether to start treatment and to determine which treatment to be started.

Next, serial measurements of brain-specific proteins can be used to monitor the effects of pharmacological interventions to protect the brain.

Third, determination of brain-specific markers may be valuable in the evaluation of possibly adverse or beneficial effects of new neuroprotective interventions.

Objectives : The aim of the present study was to investigate the serum concentration of some biochemical brain-specific proteins (NSE and CK-BB) in infants with HIE following perinatal asphyxia.

Methods : We measured both proteins at birth, in cord blood, and after 24hr in 46 asphyxiated newborn infants with history of documented abnormal CTG during the first and second stages of labor, and in 20 healthy, age, weight and sex-matched control newborn infants.

Results : At every time intervals, the mean serum concentrations of NSE and CK-BB were significantly elevated in asphyxiated infants in comparison to controls.

Also, the mean concentrations of NSE and CK-BB were significantly elevated in infants with moderate or severe HIE (100 ± 950 ug / 1 at birth &102 ± 3.10 / xg / l after 24hr for NSE, and 35.4 ± 0.805 u / 1 at birth & 38.0 ± 0.65 u / 1 after 24hr for CK-BB) compared with infants with no or mild HIE((61.0 ± 0.571 ug / 1 at birth & 67.0 ± 1.0 ug / 1 after 24hr for NSE, and 24.3 ± 0.307 u / 1 at birth & 25.7 ± 0.173 u / 1 after 24hr for CK-BB).

Also serum concentrations of NSE and CK-BB at birth had high PPV (80 %) and specificity (90).

The combination of serum NSE at birth, and cord blood metabolic acidemia, increased the PPV (97 %) and specificity (94 %) for predicting moderate or severe HIE.

Conclusion: Measurement of NSE and CK-BB concentrations in serum of newborn infants with perinatal asphyxia may be useful to identify early, and in a relatively simple way, those who are most likely to have subsequent brain injury.

Also, high levels of these proteins in presence of a significant cord blood metabolic acidemia, significantly predict moderate or severe HIE.