Serum glial fibrillary acidic protein as a biomarker of brain injury in premature neonates

Neonatal brain injury (NBI) is a serious adverse outcome of prematurity. Early detection of high risk premature neonates to develop NBI is not currently feasible. The predictive value of many biomarkers has been tested, but none is used in clinical practice. The purpose of this study was to determine the levels and predictive value of serum glial fibrillary acidic protein (GFAP) in a prospective longitudinal case-control study during the first 3 days of life in premature neonates (<34 weeks of gestation) that later developed either intraventricular hemorrhage or periventricular leukomalacia. Each case (n=29) was matched according to birth weight and gestational age to one neonate with normal head ultrasound scans. No significant differences in GFAP levels were observed between the groups. Nevertheless, neonates with brain injury presented more frequently with GFAP levels above the lowest detection limit (0.056 ng/ml) and this trend was significantly different during all 3 days. Thus, the effectiveness of GFAP as an early biomarker of NBI in premature neonates seems to be limited.