Serum neuron-specific enolase, magnetic resonance imaging, and electrophysiology for predicting neurodevelopmental outcomes of neonates with hypoxic-ischemic encephalopathy: a prospective study

Huang, Huizhi; Hu, Xiaofeng; Wen, Xuerong; Yang, Liqi

doi:10.1186/s12887-022-03329-8

Cited by 6 publications

(2 citation statements)

References 56 publications

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“…Multimodality neural monitoring (MNM) is the combination of neural monitoring techniques ( Riviello and Erklauer, 2021 ), including hemodynamic parameters and invasive and non-invasive methods described above. The 2021 guidelines of the European Resuscitation Council and European Society of Intensive Care Medicine emphasize use of combined methods to evaluate neurologic outcomes ( Nolan et al, 2021a ), as this approach is more accurate than single methods for guiding treatment ( Anetakis et al, 2022 ; Huang et al, 2022 ). In animal experiments, MNM can also be used to accurately evaluate neurologic function and explore better joint prognostic models.…”

Section: Neurologic Deficit Assessmentmentioning

confidence: 99%

Rat model of asphyxia-induced cardiac arrest and resuscitation

Zhu

et al. 2023

Front. Neurosci.

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Neurologic injury after cardiopulmonary resuscitation is the main cause of the low survival rate and poor quality of life among patients who have experienced cardiac arrest. In the United States, as the American Heart Association reported, emergency medical services respond to more than 347,000 adults and more than 7,000 children with out-of-hospital cardiac arrest each year. In-hospital cardiac arrest is estimated to occur in 9.7 per 1,000 adult cardiac arrests and 2.7 pediatric events per 1,000 hospitalizations. Yet the pathophysiological mechanisms of this injury remain unclear. Experimental animal models are valuable for exploring the etiologies and mechanisms of diseases and their interventions. In this review, we summarize how to establish a standardized rat model of asphyxia-induced cardiac arrest. There are four key focal areas: (1) selection of animal species; (2) factors to consider during modeling; (3) intervention management after return of spontaneous circulation; and (4) evaluation of neurologic function. The aim was to simplify a complex animal model, toward clarifying cardiac arrest pathophysiological processes. It also aimed to help standardize model establishment, toward facilitating experiment homogenization, convenient interexperimental comparisons, and translation of experimental results to clinical application.

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Section: Neurologic Deficit Assessmentmentioning

confidence: 99%

Rat model of asphyxia-induced cardiac arrest and resuscitation

Zhu

et al. 2023

Front. Neurosci.

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“…Neuron-specific enolase (NSE), a promising biomarker for NBI [15,16], is an enzyme that is primarily found in neurons and peripheral neuroendocrine cells [17]. It is also known as gamma-enolase and enolase 2 (ENO2).…”

Section: Introductionmentioning

confidence: 99%

Serum Neuron-Specific Enolase as a Biomarker of Neonatal Brain Injury—New Perspectives for the Identification of Preterm Neonates at High Risk for Severe Intraventricular Hemorrhage

Metallinou,

Karampas,

Pavlou

et al. 2024

Biomolecules

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Neonatal brain injury (NBI) is a critical condition for preterm neonates with potential long-term adverse neurodevelopmental outcomes. This prospective longitudinal case–control study aimed at investigating the levels and prognostic value of serum neuron-specific enolase (NSE) during the first 3 days of life in preterm neonates (<34 weeks) that later developed brain injury in the form of either periventricular leukomalacia (PVL) or intraventricular hemorrhage (IVH) during their hospitalization. Participants were recruited from one neonatal intensive care unit, and on the basis of birth weight and gestational age, we matched each case (n = 29) with a neonate who had a normal head ultrasound scan (n = 29). We report that serum NSE levels during the first three days of life do not differ significantly between control and preterm neonates with NBI. Nevertheless, subgroup analysis revealed that neonates with IVH had significantly higher concentrations of serum NSE in comparison to controls and neonates with PVL on the third day of life (p = 0.014 and p = 0.033, respectively). The same pattern on the levels of NSE on the third day of life was also observed between (a) neonates with IVH and all other neonates (PVL and control; p = 0.003), (b) neonates with II–IV degree IVH and all other neonates (p = 0.003), and (c) between control and the five (n = 5) neonates that died from the case group control (p = 0.023). We conclude that NSE could be an effective and useful biomarker on the third day of life for the identification of preterm neonates at high risk of developing severe forms of IVH.

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Predictors of Death or Severe Impairment in Neonates With Hypoxic-Ischemic Encephalopathy

Glass,

Wood,

Comstock

et al. 2024

JAMA Netw Open

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ImportanceOutcomes after hypoxic-ischemic encephalopathy (HIE) are variable. Predicting death or severe neurodevelopmental impairment (NDI) in affected neonates is crucial for guiding management and parent communication.ObjectiveTo predict death or severe NDI in neonates who receive hypothermia for HIE.Design, Setting, and ParticipantsThis prognostic study included participants enrolled in a large US clinical trial conducted in US neonatal intensive care units who were born between January 2017 and October 2019 and followed up to age 2 years. Eligible participants were neonates with moderate-severe HIE born at 36 weeks or more gestation and with 2-year outcome data. Data were analyzed June 2023. External validation was performed with a UK cohort.ExposureClinical, electroencephalography (EEG), and magnetic resonance imaging (MRI) variables were curated and examined at 24 hours and following cooling.Main Outcome and MeasuresDeath or severe NDI at age 2 years. Severe NDI was defined as Bayley Scales of Infant Toddler Development cognitive score below 70, Gross Motor Function Classification System score of 3 or higher, or quadriparesis. Model performance metrics were derived from training, internal, and external validation datasets.ResultsAmong 424 neonates (mean [SD] gestational age, 39.1 [1.4] weeks; 192 female [45.3%]; 28 Asian [6.6%], 50 Black [11.8%], 311 White [73.3%]), 105 (24.7%) had severe encephalopathy at enrollment. Overall, 59 (13.9%) died and 46 (10.8%) had severe NDI. In the 24-hour model, the combined presence of 3 clinical characteristics—(1) severely abnormal EEG, (2) pH level of 7.11 or below, and (3) 5-minute Apgar score of 0—had a specificity of 99.6% (95% CI, 97.5%-100%) and a positive predictive value (PPV) of 95.2% (95% CI, 73.2%-99.3%). Validation model metrics were 97.9% (95% CI, 92.7%-99.8%) for internal specificity, with a PPV of 77.8% (95% CI, 43.4%-94.1%), and 97.6% (95% CI, 95.1%-99.0%) for external specificity, with a PPV of 46.2% (95% CI, 23.3%-70.8%). In the postcooling model, specificity for T1, T2, or diffusion-weighted imaging (DWI) abnormality in at least 2 of 3 deep gray regions (ie, thalamus, caudate, putamen and/or globus pallidus) plus a severely abnormal EEG within the first 24 hours was 99.1% (95% CI, 96.8%-99.9%), with a PPV of 91.7% (95% CI, 72.8%-97.8%). Internal specificity in this model was 98.9% (95% CI, 94.1%-100%), with a PPV of 92.9% (95% CI, 64.2%-99.0%); external specificity was 98.6% (95% CI, 96.5%-99.6%), with a PPV of 83.3% (95% CI, 64.1%-93.4%).Conclusions and RelevanceIn this prognostic study of neonates with moderate or severe HIE who were treated with therapeutic hypothermia, simple models using readily available clinical, EEG, and MRI results during the hospital admission had high specificity and PPV for death or severe NDI at age 2 years.

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Serum neuron-specific enolase, magnetic resonance imaging, and electrophysiology for predicting neurodevelopmental outcomes of neonates with hypoxic-ischemic encephalopathy: a prospective study

Cited by 6 publications

References 56 publications

Rat model of asphyxia-induced cardiac arrest and resuscitation

Rat model of asphyxia-induced cardiac arrest and resuscitation

Serum Neuron-Specific Enolase as a Biomarker of Neonatal Brain Injury—New Perspectives for the Identification of Preterm Neonates at High Risk for Severe Intraventricular Hemorrhage

Predictors of Death or Severe Impairment in Neonates With Hypoxic-Ischemic Encephalopathy

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