S100B protein, cerebral ultrasound and magnetic resonance imaging patterns in brain injured preterm infants

Abstract

Objectives The early detection of preterm infants (PI) at risk for intraventricular hemorrhage (IVH) and neurological sequelae still constitutes an unsolved issue. We aimed at validating the role of S100B protein in the early diagnosis and prognosis of IVH in PI by means of cerebral ultrasound (CUS) and magnetic resonance imaging (MRI) today considered standard of care procedures. Methods We conducted an observational case-control study in 216 PI of whom 36 with IVH and 180 controls. Standard clinical, laboratory, radiological monitoring procedures and S100B urine measurement were performed at four time-points (first void, 24, 48, 96 h) after birth. Cerebral MRI was performed at 40–42 weeks of corrected gestational age. Results Elevated (p<0.001, for all) S100B levels were observed in the IVH group at all monitoring time-point particularly at first void when standard monitoring procedures were still silent or unavailable. S100B measured at first void correlated (p<0.001) with the grade of hemorrhage by means of CUS and with the site and extension of neurological lesion (p<0.001, for all) as assessed by MRI. Conclusions The present results showing a correlation among S100B and CUS and MRI offer additional support to the inclusion of the protein in clinical daily management of cases at risk for IVH and adverse neurological outcome. The findings open the way to further investigations in PI aimed at validating new neurobiomarkers by means of S100B.

Lutein levels in arterial cord blood correlate with neurotrophic calcium binding S100B protein in healthy preterm and term newborns

“…In the perinatal period, there is growing evidence that the pathophysiological cascade of events involved in CNS development and damage are still not fully elucidated and are subjects of investigation. More recently, it has been shown that among a series of NB, S100B appears the only one fulfilling the majority of the criteria requested by FDA, EMA and NIH statements [ 10 , 19 , 27 ].…”

“…The finding deserves further consideration bearing in mind that at this time period the brain volume, weight and structure are at their highest growing level [ 28 – 31 ]. In particular: i) magnetic resonance imaging (MRI) patterns were suggestive of the timing and duration of different myelinisation processes at the stage under investigation [ 30 ], ii) the assessment in biological fluids of NB such as S100B, activin A, G-FAP were in agreement with MRI patterns and with the biochemical, morphological and electrophysiological maturation of the CNS [ 2 – 4 , 19 , 28 , 31 ], and iii) near infrared spectroscopy patterns in the late preterm period, in healthy infants, showed an improved oxygenation status and increased tissue function suggestive of CNS development [ 32 – 34 ]. On the basis of the present findings, it is reasonable to support a LT CNS trophic role.…”

“…neuro-retinal, frontal, occipital cortex and hippocampus) [ 15 – 18 ]. In this regard, LT has been shown to be involved in CNS development through a not still understood mechanism [ 19 , 20 ]. LT trophic role has been suggested by its clinical and biochemical correlation: the former with gestational age (GA) and gender in healthy preterm/term newborns; the latter with a consolidated brain growth factor such as Activin A [ 20 ].…”

Early predictors of abnormal MRI patterns in asphyxiated infants: S100B protein urine levels

“…Among several NB currently under investigation (glial fibrillary acid protein, GFAP; activin A, adrenomedullin, oxidative stress, neuron specific enolase), the S100B protein, mainly located in glial cells and in neuronal subpopulations of the central nervous system (CNS), has been suggested as a trustable marker in different biological fluids [1][2][3][4][5][6][7][8][9][10]. It's easy measurability, reproducibility, and assessment in invasive (cerebrospinal, CSF; blood) and non-invasive biological fluids (urine, saliva) support its usefulness as an early marker of brain development/injury in neonatal intensive care units (NICU) daily practice [10][11][12]. Before this can be done, a few issues still need to be addressed.…”

“…Today, magnetic resonance imaging (MRI) is considered the gold standard for perinatal brain damage detection and prognosis in newborns complicated by intraventricular hemorrhage (IVH), perinatal asphyxia (PA) and hypoxic ischemic encephalopathy (HIE) [13,14]. In this regard, it has been previously reported that MRI patterns correlated with long-term neurodevelopment in preterm and term infants [10,11]. In the latter, the basal ganglia/watershed (BG/W) score was able to identify infants at risk for poor neuromotor and cognitive outcome at 3-12 months of age, respectively [10].…”