Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Department of Pediatrics and Neonatology, AVMC, Kirumampakkam, Puducherry, 607402, India.
Indian J Pediatr. 2020 Oct;87(10):787-792. doi: 10.1007/s12098-020-03283-2. Epub 2020 May 16.
To assess whether serum levels of neuronal biomarkers (S100 calcium-binding protein B and Neuron specific enolase) correlate with the neurodevelopmental outcome of term neonates at 18 mo who had hypoxic ischemic encephalopathy and underwent therapeutic hypothermia.
This randomized controlled trial was conducted in a tertiary care teaching hospital, south India. There were 162 term infants with moderate to severe hypoxic ischemic encephalopathy who were randomized into 2 groups (Group A and B). Neonates in Group A and B received normothermia and therapeutic hypothermia respectively. Serum levels of neuronal biomarkers were estimated at 0, 24 (±1) and 72 (±1) h after birth using sandwich ELISA in both groups. All neonates were carefully monitored till discharge. Infants who survived the neonatal period were followed up in the high risk clinic for 18 mo and neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Neurodevelopmental outcomes between the two groups were compared using Chi square test and neuronal biomarker levels between the groups were compared using Mann Whitney test.
The baseline maternal and neonatal characteristics in both groups were comparable. There was statistically insignificant lesser mortality in therapeutic hypothermia group compared to normothermia group with Risk Ratio (RR): 0.82 (28.2% vs. 34.5%, 95% CI: 0.52-1.29, p = 0.38). Among the survivors, children in therapeutic hypothermia group had better motor and mental scores compared to those in normothermia group at 18 mo. There was no significant correlation between S100B and Neuron specific enolase levels and neurodevelopmental outcome.
Serum levels of neuronal biomarkers (S100B and Neuron specific enolase) do not correlate with the long term neurodevelopmental outcome among these infants.
评估血清神经元生物标志物（S100 钙结合蛋白 B 和神经元特异性烯醇化酶）水平是否与接受治疗性低温治疗的足月患有缺氧缺血性脑病的新生儿在 18 个月时的神经发育结局相关。
本随机对照试验在印度南部的一家三级保健教学医院进行。共有 162 例中重度缺氧缺血性脑病的足月婴儿被随机分为 2 组（A 组和 B 组）。A 组和 B 组的新生儿分别接受常规体温和治疗性低温。两组均在出生后 0、24（±1）和 72（±1）小时使用夹心 ELISA 法测定血清神经元生物标志物水平。所有新生儿均接受仔细监测至出院。存活至新生儿期的婴儿在高危门诊随访 18 个月，并使用印度婴儿发育评估量表（DASII）进行神经发育评估。使用卡方检验比较两组间的神经发育结局，使用 Mann-Whitney 检验比较两组间的神经元生物标志物水平。
两组的基线母婴特征相似。治疗性低温组的死亡率明显低于常规体温组，风险比（RR）为 0.82（28.2%比 34.5%，95%CI：0.52-1.29，p=0.38）。在幸存者中，治疗性低温组的儿童在 18 个月时的运动和智力评分均优于常规体温组。S100B 和神经元特异性烯醇化酶水平与神经发育结局之间无显著相关性。
血清神经元生物标志物（S100B 和神经元特异性烯醇化酶）水平与这些婴儿的长期神经发育结局无关。
