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PS-152 Activin-a: A Biomarker Of Severe Encephalopathy
  1. AM Looney,
  2. BH Walsh,
  3. NL Denihan,
  4. GB Boylan,
  5. DM Murray
  1. The Neonatal Brain Research Group Irish Centre for Fetal and Neonatal Translational Research (INFANT) Department Paediatrics and Child Health, University College Cork, Cork, Ireland

Abstract

Background Hypoxicischaemic encephalopathy (HIE) remains one of the leading causes of neonatal morbidity and mortality. Therapeutic hypothermia may improve the outcome of infants with moderate/severe encephalopathy but only if initiated within six hours of the initial insult. The aim of our study was to determine if umbilical cord blood (UCB) levels of Activin-A, a glycoprotein previously implicated in neuronal brain injury, could identify infants with moderate/severe encephalopathy at birth.

Methods Full term infants with perinatal asphyxia (PA) were identified by a cord pH < 7.1 and/or five minute Apgar score ≤ 6 and/or requirement for intubation/CPR at birth. Following diagnosis at delivery, UCB was drawn, processed and bio-banked. HIE grade was confirmed with early continuous EEG monitoring and modified Sarnat score. Activin-A analysis was carried out using ELISA (R&D Systems).

Results In total 156 infants (controls = 78, cases = 78) were included in the study. Cases included 56 infants with PA (non-HIE) and 24 infants with HIE (mild = 14, moderate = 6, severe = 4). Following analysis, a significant increase in Activin-A expression was observed between the control and severe HIE groups, and between the perinatal asphyxia and severe HIE groups (median (SD) = 487.48 (470.21) vs 911.54(594.1) p = 0.032 and 487.95 (384.1) vs 911.54 (594.1), p = 0.035, respectively). No significant difference was seen between PA and mild or moderate HIE. Using a cut-off value of 724.5 pg/ml we report Activin-A has a 100% negative predicitive value, with a sensitivity and specificity of 100% and 70% respectively.

Conclusion Our study supports the use of Activin-A as a biomarker of severe encephalopathy.

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