Alshweki Ayham, Pérez-Muñuzuri Alejandro, López-Suárez Olalla, Baña Ana, Couce Maria L
Neonatal Unit, Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana, Santiago de Compostela, Spain.
Medicine (Baltimore). 2017 Nov;96(44):e8453. doi: 10.1097/MD.0000000000008453.
The initial diagnosis of neonatal hypoxic-ischemic encephalopathy is based on nervous system clinical manifestations. The use of biomarkers to monitor brain injury and evaluate neuroprotective effects allows early intervention and treatment. This study was designed to determine the short-term prognostic significance of urinary S100B calcium-binding protein (S100B) in asphyxiated newborns treated with hypothermia.An observational prospective study was conducted over a period of 5 years in 31 newborns with hypoxic-ischemic encephalopathy who received therapeutic hypothermia. The patients were divided into 2 groups: Group A (13 newborns with a normal neurological examination before discharge) and Group B (18 newborns who died during admission or had an abnormal neurologic examination before discharge). Urinary S100B was the main variable, serum S100B and neuron-specific enolase (NSE) were considered as secondary variables, and all of them were assessed on the first 3 days of life. The newborns were subsequently divided into groups with normal and abnormal electrophysiological and imaging findings.Mean urinary S100B levels were significantly higher in group B than group A on day 1 (10.58 ± 14.82 vs 4.65 ± 9.16 μg/L, P = .031) and day 2 (5.16 ± 7.63 vs 0.88 ± 2.53, P = .002). The optimal cutoff for urinary S100B on day 1 was >1.11 μg/L of (sensitivity, 100%; specificity 60%) for the prediction of neonatal death and < 0.66 μg/L (sensitivity 83% and specificity 70%) for the prediction of a normal neurological examination before discharge. It was not possible to calculate cutoffs with a similar accuracy for serum S100B or NSE. Urinary S100B on day 1 was higher in patients with abnormal magnetic resonance imaging findings (7.89 ± 8.09 vs 4.49 ± 9.14, P = .039) and abnormal positron emission tomography findings (8.60 ± 9.29 vs 4.30 ± 8.28, P = .038). There were no significant differences in S100B levels between patients with normal and abnormal electroencephalography results.Urinary S100B measured in the first days of life can predict neonatal death and short-term prognosis in asphyxiated newborns treated with hypothermia. The method is convenient, noninvasive, and has a higher sensitivity and specificity than measurement of serum S100B or NSE.
新生儿缺氧缺血性脑病的初步诊断基于神经系统临床表现。使用生物标志物监测脑损伤并评估神经保护作用可实现早期干预和治疗。本研究旨在确定低温治疗的窒息新生儿尿S100B钙结合蛋白（S100B）的短期预后意义。
一项观察性前瞻性研究在5年期间对31例接受治疗性低温的缺氧缺血性脑病新生儿进行。患者分为2组：A组（13例出院前神经检查正常的新生儿）和B组（18例入院期间死亡或出院前神经检查异常的新生儿）。尿S100B是主要变量，血清S100B和神经元特异性烯醇化酶（NSE）被视为次要变量，所有这些均在出生后的前3天进行评估。随后将新生儿根据电生理和影像学检查结果正常和异常分为不同组。
第1天（10.58±14.82 vs 4.65±9.16μg/L，P = 0.031）和第2天（5.16±7.63 vs 0.88±2.53，P = 0.002）时，B组的平均尿S100B水平显著高于A组。第1天尿S100B预测新生儿死亡的最佳截断值>1.11μg/L（敏感性100%；特异性60%），预测出院前神经检查正常的最佳截断值<0.66μg/L（敏感性83%，特异性70%）。血清S100B或NSE无法计算出具有类似准确性的截断值。磁共振成像检查结果异常的患者（7.89±8.09 vs 4.49±9.14，P = 0.039）和正电子发射断层扫描检查结果异常的患者（8.60±9.29 vs 4.30±8.28，P = 0.038）第1天的尿S100B水平更高。脑电图结果正常和异常的患者之间S100B水平无显著差异。
出生后最初几天测量的尿S100B可预测低温治疗的窒息新生儿的新生儿死亡和短期预后。该方法方便、无创，并且比血清S100B或NSE测量具有更高的敏感性和特异性。
