Clinical Significance Of Serum GFAP And PNF-H Levels In The Assessment Of Brain Injury In Preterm Infants With Asphyxia

ObjectiveTo explore the correlation between serum GFAP and pNF-H levels and asphyxia brain injury in preterm infants with asphyxia.To analyze the differences in serum GFAP and pNF-H levels between the asphyxia brain injury group and the asphyxia non-brainbrain injury group and whether they were correlated with NBNA and DST results,so as to provide a reference for the diagnosis of brain injury in asphyxiated preterm infants.MethodsA total of 60 premature infants with asphyxia admitted to Taizhou People’s Hospital affiliated to Nanjing Medical University from May 2021 to May 2022 were selected to exclude complications such as central nervous system infection,chromosomal diseases and severe cardiopulmonary diseases.According to the 2012 Expert Consensus on the Diagnosis and Prevention of Brain Injury in Preterm Infants by the Neonatologist Branch of the Chinese Medical Doctor Association,60 cases were divided into 29 cases in the brain injury group and 31 cases in the non-brain injury group according to clinical manifestations,head MRI,cranial B-ultrasound and EEG test results.All enrolled children had blood collected 1 day and 3 days after birth.Enzyme-linked immunosorbent(ELISA)method detected GFAP and pNF-H levels in serum 1 and 3 days after birth.SPSS 27.0 statistical software and Graph Pad Prism were used to statistically analyze the difference between serum GFAP and pNF-H levels between the brain injury group and the non-brain injury group <0.05 was statistically significant.At 40 weeks’ corrected gestational age,the Neonatal Neurobehavioral Assay Score(NBNA)is performed,and at 6 months of corrected age,the Neuropsychological Development Examination Scale(DST)is performed for children aged 0-6 years.The Pearson method analyzed the correlation between serum GFAP and pNF-H levels and NBNA score and DST.To assess the diagnostic value of serum GFAP and pNF-H for brain injury in preterm infants with asphyxia.Results1.Comparison of general clinical data: there was no significant difference in gender,delivery mode,birth weight,gestational age,and 1min Apgar score between the asphyxiated brain injury group and the asphyxia non-brain injury group(P>0.05).2.Comparison of serum GFAP and pNF-H levels in brain injury group and non-brain injury group: On the same day,serum GFAP and pNF-H levels in brain injury group were higher than those in the non-brain injury group,and the difference was statistically significant(P<0.05).3.Brain injury group and non-brain injury group were compared between different time groups: serum GFAP and pNF-H levels in the brain injury group were higher than those in 1 day after birth,and the difference was statistically significant(P<0.05).There was no significant difference in serum levels between 1 and 3 days after birth in the group without brain injury(P>0.05).4.At 3 days after birth,serum GFAP and pNF-H levels were negatively correlated with NBNA score(r=-0.531,-0.486,P<0.001),and negatively correlated with DST score(r=-0.519,-0.543,P<0.001).5.ROC curve analysis,serum GFAP was 79.3% sensitive to diagnose brain injury in preterm infants with asphyxia,specificity was 80.6%,truncated value was 9.57ng/m L,and the area under the curve was 0.874.The sensitivity of pNF-H in the diagnosis of brain injury in preterm infants with asphyxia was 62.1%,the specificity was 87.1%,the area under the curve was 0.794,and the cut-off value was 299.76 pg/m L.The combined diagnosis of GFAP and pNF-H had a sensitivity of 80.0%,a specificity of 87.1%,and an area under the curve of 0.892.Conclusions1.There were obvious differences between serum GFAP and pNF-H levels in children with asphyxia brain injury and non-cerebral injury group,suggesting that the detection of serum GFAP and pNF-H levels was helpful for the diagnosis of brain injury in preterm infants with asphyxia,and the combined diagnostic value was higher than that of individual diagnosis.2.Serum GFAP and pNF-H levels were negatively correlated with NBNA and DST results,suggesting that serum GFAP and pNF-H can predict neurodevelopmental outcomes to a certain extent.