Umbilical cord blood biomarkers of neurologic injury and the risk of cerebral palsy or infant death

To evaluate the association between cerebral palsy (CP) or infant death and putative cord blood biomarkers of neurologic injury, we performed a nested case–control secondary analysis of a multicenter randomized trial of magnesium sulfate (MgSO4) versus placebo to prevent CP or death among offspring of women with anticipated delivery from 24 to 31 weeks’ gestation. Cases were infants who died by 1 year (n = 25) or developed CP (n = 16), and were matched 1:2 to a control group (n = 82) that survived without developing CP. Umbilical cord sera concentrations of S100B, neuron-specific enolase (NSE) and the total soluble form of the receptor for advanced glycation end-products (sRAGE) were measured by ELISA in duplicates. Maternal characteristics were similar between the 2 groups. Cases were born at a lower gestational age (GA) and had lower birth weight compared with controls. There were no differences in concentrations of the three biomarkers and the composite outcome of CP or infant death. However, S100B was higher (median 847.3 vs. 495.7 pg/ml; P = 0.03) in infants who had CP and total sRAGE was lower (median 1259.3 vs. 1813.1 pg/ml; P = 0.02) in those who died compared with the control group. When corrected for delivery GA and treatment group, both differences lost statistical significance. In conclusion, cord blood S100B level may be associated with CP, but this association was not significant after controlling for GA and MgSO4 treatment.

► In univariable analysis, cord S100B were higher in neonates who developed CP compared to controls.
► In univariable analysis, cord sRAGE were lower in neonates who died compared to controls.
► No differences in cord NSE or sRAGE between neonates who developed CP and controls.
• None of the biomarkers was associated with the composite outcome of death or CP.
► Our findings do not negate that markers of neurologic damage leading to CP may be detected at birth.