WIP 63 - Biomarkers for Timing of Brain Injury in Infants with Hypoxic Ischemic Encephalopathy

Poster Number: WIP 63
Publication Number: WIP 63.2530

Background: Hypoxic-ischemic encephalopathy (HIE) occurs in 1.5 per 1000 live births and can cause irreversible damage to the brain. Therapeutic hypothermia (TH) is the only proven therapy for infants with moderate to severe HIE if initiated within 6 hours of birth. This demonstrates the importance of the timing of the injury as well as having accurate, early diagnostic tools of HIE. Serum biomarkers for neonatal HIE, such as nucleated red blood cell (NRBC) count and troponin, may help determine the timing of the ischemic event as acute or subacute. The time from the hypoxic insult to the appearance of biomarkers in the serum is known as the emergence time. The presence of elevated NRBC and troponin levels shortly after birth may indicate the injury was subacute as sufficient time has passed from the injury for their emergence.

Objective: The aim of this study is to determine if NRBC and troponin levels shortly after birth (within 4 hours of age) are associated with non-acute brain injury.

Design/Methods: This is a retrospective case-control study. The study population includes 380 neonates admitted to the level III NICU between November 2006 and January 2021. Inclusion criteria for subjects include infants born at ≥35 weeks gestation with moderate to severe HIE who received TH and had brain MRI after rewarming or died. The subjects will be divided into two groups based on the presence or absence of perinatal sentinel event (PSE). PSE includes shoulder dystocia, head entrapment, uterine rupture, placental abruption, umbilical cord prolapse or cord knot, and maternal cardiopulmonary arrest. The groups are: (1) Acute brain injury (PSE group) and (2) No acute brain injury (no PSE group). NRBC count and troponin were measured in the infant’s serum within 4 hours of birth and at 24 hours of life. Levels of NRBCs and troponin will be compared between PSE and no PSE groups. The study is IRB approved. Timeline: Continue data collection in November, December. Data analysis in January, February.