Document Detail


Potential biomarkers for hypoxic-ischemic encephalopathy.
MedLine Citation:
PMID:  20646975     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cerebral hypothermia reduces brain injury and improves behavioral recovery after hypoxia-ischemia (HI) at birth. However, using current enrolment criteria many infants are not helped, and conversely, a significant proportion of control infants survive without disability. In order to further improve treatment we need better biomarkers of injury. A 'true' biomarker for the phase of evolving, 'treatable' injury would allow us to identify not only whether infants are at risk of damage, but also whether they are still able to benefit from intervention. Even a less specific measure that allowed either more precise early identification of infants at risk of adverse neurodevelopmental outcome would reduce the variance of outcome of trials, improving trial power while reducing the number of infants unnecessarily treated. Finally, valid short-term surrogates for long term outcome after treatment would allow more rapid completion of preliminary evaluation and thus allow new strategies to be tested more rapidly. Experimental studies have demonstrated that there is a relatively limited 'window of opportunity' for effective treatment (up to about 6-8h after HI, the 'latent phase'), before secondary cell death begins. We critically evaluate the utility of proposed biochemical, electronic monitoring, and imaging biomarkers against this framework. This review highlights the two central limitations of most presently available biomarkers: that they are most precise for infants with severe injury who are already easily identified, and that their correlation is strongest at times well after the latent phase, when injury is no longer 'treatable'. This is an important area for further research.
Authors:
L Bennet; L Booth; A J Gunn
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2010-06-19
Journal Detail:
Title:  Seminars in fetal & neonatal medicine     Volume:  15     ISSN:  1878-0946     ISO Abbreviation:  Semin Fetal Neonatal Med     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-08-30     Completed Date:  2010-12-20     Revised Date:  2014-09-21    
Medline Journal Info:
Nlm Unique ID:  101240003     Medline TA:  Semin Fetal Neonatal Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  253-60     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Asphyxia Neonatorum / complications*,  metabolism
Biological Markers / metabolism*
Creatinine / metabolism
Developmental Disabilities / metabolism,  prevention & control
Humans
Hypothermia, Induced / methods
Hypoxia-Ischemia, Brain / diagnosis*,  etiology,  metabolism*,  therapy
Infant, Newborn
Lactic Acid / metabolism
Nerve Growth Factors / metabolism
Prognosis
S100 Proteins / metabolism
Grant Support
ID/Acronym/Agency:
R21 NS063141/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Nerve Growth Factors; 0/S100 Proteins; 33X04XA5AT/Lactic Acid; AYI8EX34EU/Creatinine
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