TY - JOUR
T1 - Glial fibrillary acidic protein as a biomarker for brain injury in neonatal CHD
AU - McKenney, Stephanie L.
AU - Mansouri, Fahad F.
AU - Everett, Allen D.
AU - Graham, Ernest M.
AU - Burd, Irina
AU - Sekar, Priya
N1 - Funding Information:
The authors acknowledge partial support for the statistical analysis from the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the ational Institutes of Health through Grant Number 1UL1TR001079. The authors thank their colleague, Jiangxia Wang, MS, MA, with the Johns Hopkins Institute for Clinical and Translational Research, who provided insight and expertise in biostatistics that greatly assisted the research. They also thank Michael V. Johnston, MD, Vice President and Chief Medical Officer at Kennedy Krieger Institute and Professor in the Department of Neurology and Pediatrics at Johns Hopkins University School of Medicine, for his assistance and feedback.
Publisher Copyright:
© Cambridge University Press 2016.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - CHD
KW - Glial fibrillary acidic protein
KW - neurological injury
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U2 - 10.1017/S1047951115002346
DO - 10.1017/S1047951115002346
M3 - Article
C2 - 26786018
AN - SCOPUS:84954505727
VL - 26
SP - 1282
EP - 1289
JO - Cardiology in the Young
JF - Cardiology in the Young
SN - 1047-9511
IS - 7
ER -