Upcoming trials of neuroprotective strategies in severely asphyxiated newbo
rn infants emphasize the need for early and objective markers of both good
and bad long-term prognosis. Traditional markers such as neurological depre
ssion and seizures are not specific. Aim: To study whether measurement in t
he cerebrospinal fluid of some proteins known to be specific to the central
nervous system was in covariance with the clinical course and long-term pr
ognosis. Methods: Twenty-two asphyxiated infants were included in the study
and compared with a control group of 8 infants without signs of perinatal
asphyxia. Cerebrospinal fluid (CSF) was collected during the first 4 d of l
ife and analysed for neurofilament protein (NFp), glial fibrillary acidic p
rotein (GFAp), protein S-100 and neuron-specific enolase (NSE). Results: Th
e concentrations of all four proteins were significantly increased in the C
SF of asphyxiated infants. The concentrations correlated significantly with
other indicators of long-term prognosis and to neurological impairment at
1 y of age, or death before that time. Specifically, concentrations were ex
cessively high in the five infants who died.
Conclusions: High concentrations of brain-specific proteins are released in
to the CSF of asphyxiated infants. It might therefore be useful to measure
these concentrations when excluding patients with the gravest prognosis fro
m neuroprotective trials.