Neurological Assessment Tools and Inflammatory Biomarkers for Predicting Cerebral Palsy in Neonatal HIE.

Background

To evaluate temporal changes in serum interleukin-40 (IL-40), hypoxia-inducible factor-1 alpha (HIF-1α), and procalcitonin (PCT) levels between early and post-rewarming measurements in neonates with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH), and to determine the prognostic value of these biomarkers together with the Hammersmith Neonatal Neurological Examination (HNNE), amplitude-integrated electroencephalography (aEEG), and magnetic resonance imaging (MRI) for predicting cerebral palsy (CP).

Methods

Thirty-five neonates with HIE treated with TH and 20 healthy term neonates were prospectively enrolled. Serum IL-40, HIF-1α, and PCT levels were measured before and after TH. Associations between biomarkers, HNNE, aEEG, MRI findings, and CP at follow-up were evaluated.

Results

Serum IL-40, HIF-1α, and PCT levels decreased significantly between the early and post-rewarming measurements (all p < 0.001). Although biomarker levels differed from controls, they were not associated with subsequent CP. In contrast, HNNE, aEEG, and MRI showed strong prognostic performance for subsequent CP among surviving infants.

Conclusion

Serum IL-40, HIF-1α, and PCT levels showed significant temporal decreases between the early and post-rewarming measurements in neonates with HIE undergoing TH; however, these biomarkers did not predict subsequent CP among surviving infants. HNNE, aEEG, and MRI each demonstrated strong prognostic performance for subsequent CP when evaluated individually in this cohort.