Agarwal Ankit, Zamorano Miriam, Collier Aidan, Oldham Braden, Riggs-Harpur Kaleigh, Nguyen Thao L, Sandberg David I, Fletcher Stephen A, Shah Manish N, Miller Brandon A
Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
World Neurosurg. 2025 Aug;200:124177. doi: 10.1016/j.wneu.2025.124177. Epub 2025 Jun 13.
This study investigated changes in hemoglobin and neuroinflammatory and brain injury biomarkers (tumor necrosis factor-alpha [TNF-α] and glial fibrillary acidic protein [GFAP]) in early stages of cerebrospinal fluid (CSF) diversion in preterm neonates with intraventricular hemorrhage (IVH). We hypothesized that patients with higher CSF hemoglobin levels would have higher TNF-α and GFAP levels.
This prospective study included infants with grade 3 or 4 IVH. All had ventricular reservoirs that were placed following standard neurosurgical care. The first CSF sample was collected on the day of reservoir placement. Subsequent samples were from clinically indicated CSF withdraws to decompress ventricles. Enzyme-linked immunosorbent assays were performed using commercially available kits and standard methods.
Eight preterm infants were included in the study. Median postmenstrual age was 26.3 weeks, and median birth weight was 765 g. No biomarkers investigated had a significant correlation with days since reservoir placement. Initially, GFAP and hemoglobin were significantly correlated (Pearson's r = -0.682, P < 0.001), so a linear regression was conducted (slope = -0.00363). However, this relationship was lost when the power of repeated measures analysis was leveraged (repeated measures correlation r = -0.473, P = 0.055, Bonferroni adjusted alpha level = 0.008).
This study found no significant correlation between CSF hemoglobin, TNF-α, and GFAP in the first weeks of CSF diversion in neonates with IVH. There is high variability of these measures, even within subjects. This study reveals the need for further research into neuroinflammatory and brain injury biomarkers in neonates with IVH, their usefulness in clinical decision-making, and long-term outcomes.
