ABSTRACT:Preterm infants are at risk of developing sepsis, necrotizing enterocolitis (NEC), chronic lung disease (CLD), and retinopathy of prematurity (ROP). We used high-throughput mass spectrometry to investigate whether cord blood proteins can be used to predict development of these morbidities. Cord blood plasma from 44 infants with a birth weight of Ͻ1500 g was analyzed by surfaceenhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF). Six infants developed ROP Նstage II, 10 CLD, three sepsis, and one NEC. We detected 814 protein signals representing 330 distinct protein species. Nineteen biomarkers were associated with development of Նstage II ROP [false-discovery rate (FDR) Ͻ5%] and none with CLD. Several proteins with molecular weight (M r ) 15-16 kD and pI 4 -5 were detected with increased abundance in infants with ROP, while similar M r proteins with pI 7-9 were less abundant in these patients. Sodium dodecylsulfatepolyacrylamide gel electrophoresis (SDS-PAGE) and sequence analysis identified these proteins as ␣-, -, and ␥-globin chains. Partial deamidation of Asn139 in -globin chains was observed only in the pI 4 -5 proteins. We conclude that there are several promising biomarkers for the risk of ROP. Deamidation of globin chains is especially promising and may indicate underlying prenatal pathologic mechanisms in ROP. Validation studies will be undertaken to determine their clinical utility. (Pediatr Res 61: 215-221, 2007) P reterm infants are at risk of developing complications such as sepsis, NEC, CLD, and ROP (1-6). Approximately 0.3%-3.2% of low birth weight infants (501-1500 g) have more than one of these morbidities (3). The reason why some preterm infants of the same gestational age have a mild neonatal course while others go on to develop particular morbidities is of great interest to neonatologists. It has been hypothesized that the release of proinflammatory cytokines such as interleukin (IL)-6, IL-1, IL-8, tumor necrosis factor ␣ in amniotic fluid and other body fluids before birth may play a role in several adverse outcomes, including CLD, periventricular leukomalacia (PVL), and cerebral palsy (4,7-9).Biomarker molecules that could identify the onset of or susceptibility for a particular disease would be valuable. Low molecular weight proteins present in plasma offer the potential to be such biomarkers. Several techniques can be used to identify these proteins or potential biomarkers. Antibody arrays can be useful in detection of proteins in disease states where there is a known panel of proteins implicated in the disease process. However, other methods for detection are needed in multifactorial diseases where the identity of the protein involved in the molecular pathogenesis is not yet known. Two-dimensional (2-D) electrophoresis is one such method that is useful as a screening technique for identification of proteins Ͼ20 kD. Another strategy is to screen and identify protein biomarkers using mass spectrometry (MS), an analytical technique that identifies unk...