Value of specific proteins of the nervous system in the diagnosis of neonatal hypoxic ischemic encephalopathy

Objective To determine some specific proteins of the nervous system such as the neuron specific enolase (NSE), S 100 protein (S 100), myelin basic protein (MBP) and creatine kinase isoenzyme BB (CK BB) in cerebrospinal fluid (CSF) and plasma of asphyxiated newborns during early stage of hypoxic ischemic encephalopathy (HIE), and its correlation with the severity of the disease and long term outcome. Methods 71 full term and near full term neonates were enrolled in the study. 16 babies without neurological disease were assigned to the control group. Another 55 babies were in the HIE group. Among them, there were 20 with mild HIE, 28 with moderate , and 7 with severe HIE. CSF and plasma specimens were obtained at 9 92 hours (mean: 33.5 hours) postnatal in the HIE group. NSE/S 100/MBP were measured by immunoradiometric assay, CK BB by agarose electrophoresis. Babies with HIE were followed up after discharged from the hospital. Neurological outcome was assessed by physical examination and Gesell developmental diagnosis. Results 80% (41/51) of the infants survived at the time of discharge were followed up for 3～13 months (mean:6.5 months). 25 infants were normal, 9 slightly abnormal, and 7 seriously abnormal. Although the plasma levels of NSE, and CK BB correlated with the degree of HIE, they could not predict accurately the long term outcome. NSE, S 100, MBP and CK BB in CSF were correlated not only to the severity of the disease, but also to the long term outcome. Among the four markers, NSE and S 100 were the most sensitive and specific in the prediction of the degree of brain injury. Conclusion NSE and S 100 in CSF are the most reliable markers for early estimation of the degree of HIE in neonates.