No abstract

Perinatal infections such as bacterial meningitis (BM) are one of the major factors associated with perinatal brain damage (1-4 ). Despite accurate monitoring, the early stages of meningitis are crucial because brain damage may occur at a subclinical stage when ultrasound assessment is still silent (5, 6 ). Laboratory assessment is based on chemical analysis of cerebrospinal fluid (CSF) and the detection of bacteria, and the possibility of detecting cases at risk of brain damage is to date limited. The measurement of brain constituents able to diagnose subclinical lesions at this stage could therefore be useful. S100B is a calcium-binding protein primarily present in nervous tissue (7)(8)(9). Increased S100B in biological fluids has been shown to be a marker of brain damage both in adults and during the antenatal and postnatal periods (10 -16 ).The present case-control study is aimed at investigating whether the measurement of S100B in CSF could also be useful in infants with BM for the early detection of cases at risk of encephalitis.Samples of CSF were collected from infants consecutively admitted between April 1998 and June 2000 to our tertiary referral center for intensive care for infectious diseases. For the present study we identified from our database 44 patients with BM and matched them for gestational age at sampling with 44 patients without BM (1 BM case vs 1 control). We retrieved clinical, laboratory, and routine CSF test data and CSF S100B concentrations.Eligibility criteria for infants with BM were as follows: clinical (respiratory distress, lethargy, presence/absence of minor/major neurologic symptoms, feeding and abdominal distension problems, temperature instability or increases, unexplained recurrent hypoglycemia, poor vascular perfusion) and laboratory signs of septicemia with altered CSF results (leukocyte count, protein, glucose, visible bacteria) (17 ). Causative bacteria were gram-positive cocci (Streptococcus agalactiae) in 19 cases, unidentified gram-positive cocci in 12 cases, and gram-negative rods (Haemophilus influenzae or Escherichia coli) in 13.For ethical reasons, the healthy group consisted of infants in whom CSF samples had been collected to investigate confirmed or probable meningitis. Infants were included in the control group when CSF findings of meningeal inflammation such as CSF leukocyte count and protein and glucose concentrations were normal and CSF culture or bacterial antigen test results were negative (17 ). An additional criterion for admission to the control group was that the ultrasound patterns were negative for encephalitis and for central nervous system diseases. Exclusion criteria were fetal or neonatal central nervous system malformations, chromosomal abnormalities, perinatal asphyxia, and congenital heart disease.In the control group septicemia was identified (15 of 44 with unidentified gram-positive cocci, 22 of 44 with Staphylococcus epidermidis, and 7 of 44 with Staphylococcus species).All recruited infants were delivered at term without apparent perinata...

Gazzolo D, Masetti P, Meli M, Grutzfeld D, Michetti F. Elevated S100B protein as an early indicator of intracranial haemorrhage in infants subjected to extracorporeal membrane oxygenation. Acta Paediatr 2002; 91: 218-221. Stockholm. ISSN 0803-5253 The aim of this investigation was to verify whether plasma S100B could be a useful tool in identifying which infants subjected to extracorporeal membrane oxygenation (ECMO) might develop intracranial haemorrhage (ICH). A case-control study of eight infants who developed ICH during ECMO was conducted. Plasma samples collected daily after ECMO insertion were assessed for S100B and compared with those obtained from eight infants supported by ECMO who did not develop ICH. Cerebral ultrasound and Doppler velocimetry waveform patterns in the middle cerebral artery (MCA PI) were also recorded at the same time as blood sampling. S100B blood concentrations were signi cantly higher in the group of infants with ICH 72 h before any signs of haemorrhage could be detected by ultrasound (ICH: 2.91 § 0.91 mg/L vs. control: 0.53 § 0.15 mg/ L), reaching their peak at day 6, when cerebral ultrasound scan patterns were suggestive of intracranial haemorrhage (ICH: 3.50 § 1.03 mg/L vs. control: 0.66 § 0.27 mg/L) (p < 0.05, for both). The highest S100B levels were observed in the three ICH infants who expired during the ECMO procedure (3.43 mg/L, 4.0 mg/L, 4.12 mg/L, respectively). MCA PI values in the ICH group were also signi cantly higher, but only 24 h before any ultrasound pattern of bleeding was detected (ICH: 2.31 § 0.22 vs control: 1.81 § 0.24) (p < 0.05). Conclusion:This study suggests that blood S100B measurement could be a promising tool for the identi cation of infants at risk of ICH when imaging assessment and clinical symptoms of haemorrhage might still be silent.