Metallinou Dimitra, Karampas Grigorios, Lazarou Eleftheria, Iacovidou Nikoletta, Pervanidou Panagiota, Lykeridou Katerina, Mastorakos George, Rizos Demetrios
Department of Midwifery, University of West Attica, Ag. Spyridonos Street, 12243 Egaleo, Greece.
2nd Department of Obstetrics and Gynecology, Aretaieio University Hospital, 46 Vasilissis Sofias Avenue, 11528 Athens, Greece.
Brain Sci. 2021 Sep 20;11(9):1243. doi: 10.3390/brainsci11091243.
Disruption of normal intrauterine brain development is a significant consequence of premature birth and may lead to serious complications, such as neonatal brain injury (NBI). This prospective case-control longitudinal study aimed at determining the levels and prognostic value of serum activin A during the first three days of life in human premature neonates which later developed NBI. It was conducted in a single tertiary hospital and eligible participants were live-born premature (<34 weeks) neonates. Each case ( 29) developed NBI in the form of an intraventricular haemorrhage, or periventricular leukomalacia, and was matched according to birth weight and gestational age to one neonate with normal head ultrasound scans. Serum activin A levels in both groups showed a stable concentration during the first three days of life as no difference was observed within the two groups from the first to the third day. Neonates diagnosed with NBI had significantly higher activin A levels during the first two days of life compared to control neonates and its levels correlated to the severity of NBI during the second and third day of life. Although serum activin A on the second day was the best predictor for neonates at risk to develop NBI, the overall predictive value was marginally fair (area under the ROC-curve 69.2%). Activin A, in combination with other biomarkers, may provide the first clinically useful panel for the early detection of premature neonates at high risk of NBI.
正常宫内脑发育中断是早产的一个重要后果，可能导致严重并发症，如新生儿脑损伤（NBI）。这项前瞻性病例对照纵向研究旨在确定人类早产新生儿出生后前三天血清激活素A的水平及其对后来发生NBI的预后价值。该研究在一家三级医院进行，符合条件的参与者为活产早产（<34周）新生儿。每个病例（29例）以脑室内出血或脑室周围白质软化的形式发生NBI，并根据出生体重和胎龄与一名头部超声扫描正常的新生儿进行匹配。两组血清激活素A水平在出生后前三天呈稳定状态，从第一天到第三天两组间未观察到差异。与对照新生儿相比，诊断为NBI的新生儿在出生后前两天的激活素A水平显著更高，且其水平与出生后第二天和第三天NBI的严重程度相关。虽然第二天的血清激活素A是发生NBI风险新生儿的最佳预测指标，但总体预测价值仅为中等（ROC曲线下面积为69.2%）。激活素A与其他生物标志物联合使用，可能为早期检测有NBI高风险的早产新生儿提供首个具有临床实用性的指标组合。
