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Abstract
Intraventricular hemorrhage is an important cause of cognitive and motor neurological impairment in preterm infants, and is associated with high morbidity and mortality rates in the neonatal period. Early and accurate evaluation of the severity of this brain insult remains one of the most difficult problems in neonatal care units.
The aim of our study was to evaluate a nervous system specific protein (S100b protein), an early marker to assess the extent of intraventricular hemorrhage and predict the neurological outcome.
The study was conducted in the neonatal intensive care unit of El-Galaa hospital. It included 30 preterm infants with gestational age ranging from 28-34 weeks and birth weight ranging between 800-1700 gm. The neonates included in this study were divided into three groups, group 1 comprised five sick preterms but without intraventricular hemorrhage, group 2 comprised 15 preterm infants suffering from intraventricular hemorrhage, and a healthy group with comparable gestational age and birth weight serving as a control group.
All studied neonates were subjected to full prenatal and perinatal history and a thorough clinical examination with assessment of Apgar score at 1 and 5 minutes after birth.
General and neurological examination were done at inclusion. Complete blood count, C-reactive protein, arterial blood gases, chest X-ray was done for all preterms to diagnose grades of RDS, serum level of S100b protein was drawn within the first 48 hours after birth and estimated by chemiluminesent technique and cranial ultrasonography also was done for assessment of the grades of intraventricular hemorrhage.
On the 7th day, a neurological reevaluation was done and patients were considered to have an abnormal outcome if one or more of the following neurological syndromes were present: hyper- or hypokinesia, hyper- or hypotonia, apathy syndrome, hyperexitability syndrome and asymmetry.
The results of the study revealed that S100b protein was markedly elevated in preterm infants with intraventricular hemorrhage compared to other sick preterms and to the healthy group.
A significant difference in levels of S100b protein was elicited between the different grades of intraventricular hemorrhage, where S100b levels were significantly increased as the severity of the disease increased. Survivors had much lower levels compared to non survivors.
There is no statistically significant correlation between serum levels of S100b protein and both gestational age and birth weight. However, there was statistically significant negative correlation between serum levels of S100b protein and Apgar score at both first and 5th minutes. Also, there was significant positive correlation between serum level of S100b protein and each of RDS and intraventricular hemorrhage grades in sick preterms.
In conclusion, serum levels of S100b was significantly increased in sick preterm infants with intraventricular hemorrhage and was significantly related to the degrees of intraventricular hemorrhage and of the respiratory distress.
Thus, it seems that an early estimation of S100b protein in the sera of preterm infants can provide a direct indicator of active cell damage of CNS.
Also, our results suggest that S100b protein levels may be of value as a predictive of outcome, being increased in those patients with poor outcome.