Can urinary excretion rate of malondialdehyde, uric acid and protein predict the severity and impending death in perinatal asphyxia?

The identification of early noninvasive biochemical markers of disease is a crucial issue of the current scientific research, particularly during the first period of life, since it could provide useful and precocious diagnostic information when clinical and radiological signs are still silent. The ideal biomarker should be practical and sensitive in the precocious identification of at risk patients. An earlier diagnosis may lead to a larger therapeutic window and improve neonatal outcome. Brain damage and sepsis are common causes of severe morbidity with poor outcome and mortality during the perinatal period. A large number of potential biomarkers, including neuroproteins, calcium binding proteins, enzymes, oxidative stress markers, vasoactive agents, and inflammatory mediators, have been so far investigated. The aim of the present review was to provide a brief overview of some of the more commonly investigated biomarkers used in case of neonatal brain damage and sepsis.

/pdf/use-of-early-biomarkers-in-neonatal-brain-damage-and-sepsis-397ayxa77n.pdf

Use of early biomarkers in neonatal brain damage and sepsis: state of the art and future perspectives.

Activin-A is a protein over-expressed and secreted by the brain after neuronal destruction. We evaluated whether serum activin-A increases in asphyxiated full-term newborns (AFTNs) at risk of hypoxic-ischemic-encephalopathy (HIE). 105 consecutive infants (35 affected by perinatal asphyxia due to acute fetal distress; 70 healthy gestational-age matched newborns) underwent cranial assessment and neurologic examination at 12, 24 and 72 hours after birth and, on discharge from the hospital and; activin-A and monitoring laboratory variables assessment at birth. According to the occurrence of HIE within 7-days after birth, AFTNs were subdivided in Group A (n= 20; no/mild HIE with good prognosis) and Group B (n= 15; moderate/severe HIE with a greater risk of neurological handicap). Activin-A was significantly (P less than 0.0001) higher in Groups A and B than controls and highest (P less than 0.001) in Group B. At 0.66 ng/L activin-A achieved a sensitivity of 93.33 per cent and a specificity of 96.63 per cent, respectively, as HIE diagnostic test. These findings show that activin A increased in AFTNs with HIE before the appearance of related signs.

Activin A in asphyxiated full-term newborns with hypoxic ischemic encephalopathy.

The potentials and limitations of neuro-biomarkers as predictors of outcome in neonates with birth asphyxia

Objective: There is growing evidence on the usefulness of biomarkers in the early detection of preterm infants at risk for brain damage. However, among different tools Activin A, S100B protein and adrenomedullin assessment offer the possibility to investigate brain/multiorgan function and development. This could be especially useful in perinatal medicine that requires even more non-invasive techniques in order to fulfill the minimal handling in diagnostic and therapeutic strategy performance. Materials and methods: The concept of Unconventional Biological Fluid (UBF: urine and saliva) is becoming even stronger and regards the assessment in non-invasive biological fluids of biochemical markers involved in the cascade of events leading to brain damage. Results: Activin A, S100B protein and adrenomedullin in UBF were increased in preterm newborns developing brain damage and/or ominous outcome. Conclusions: The present manuscript offers an update on the usefulness of Activin A, S100B protein an adrenomedullin...

Biomarkers of brain damage in preterm infants.

Background: Hypoxic ischemic encephalopathy (HIE) is a major cause of permanent neurological disabilities in full-term newborns. We measured activin A in urine collected immediately after birth in asphyxiated full-term newborns, and assessed the ability of the measurements to predict the occurrence of perinatal encephalopathy.

Methods: We studied 30 infants with perinatal asphyxia and 30 healthy term neonates at the same gestational age. We recorded routine laboratory variables, cranial assessments by standard cerebral ultrasound, and the presence or absence of neurological abnormalities during the first 7 days after birth. Urinary activin A concentrations were measured at first urination and 12, 24, 48, and 72 h after birth.

Results: Asphyxiated infants were subdivided as follows: group A (n = 18): no or mild HIE with good prognosis and group B (n = 12): moderate or severe HIE with a greater risk of neurological handicap. Activin A concentrations in urine collected at birth (median collection time at first urination 0.08 μg/L at first urination in 10 of 12 patients with moderate or severe HIE but in none of 18 patients with no or mild HIE.

Conclusions: Activin A measurements in urine soon after birth may be a promising tool to identify which asphyxiated infants are at risk of neurological sequelae.

/pdf/high-urinary-concentrations-of-activin-a-in-asphyxiated-full-31en0xwco5.pdf

High Urinary Concentrations of Activin A in Asphyxiated Full-Term Newborns with Moderate or Severe Hypoxic Ischemic Encephalopathy

Maternal Fetal and NeonatalHealth G. Garibaldi Hospital, Catania, Siena, Genoa andCatania, Italy; *address correspondence to this author at:Department of Pediatrics, Obstetrics and ReproductiveMedicine, Section of Obstetrics and Gynecology, Univer-sity of Siena, Policlinico “ Le Scotte”, viale Bracci 53100Siena, Italy; fax 39-0577-233-454; e-mail petraglia@unisi.it)

High Urinary Concentrations of Activin A in Asphy- xiated Full-Term Newborns with Moderate or Severe

High Urinary Concentrations of Activin A in Asphyxi- ated Full-Term Newborns with Moderate or Severe Hypoxic Ischemic Encephalopathy Pasquale Florio, 1 Ste-

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High Urinary Concentrations of Activin A in Asphyxiated Full-Term Newborns with Moderate or Severe Hypoxic Ischemic Encephalopathy

High Urinary Concentrations of Activin A in Asphy- xiated Full-Term Newborns with Moderate or Severe

High Urinary Concentrations of Activin A in Asphyxi- ated Full-Term Newborns with Moderate or Severe Hypoxic Ischemic Encephalopathy Pasquale Florio, 1 Ste-