Despite decreases in the rate of perinatal mortality due to technological improvements, the early detection of brain damage in fetuses and newborns still constitutes an unresolved issue. Early detection of neural damage in the periods immediately before and after birth is crucial, because this type of injury can cause a life-long handicap. The validation of useful biomarkers is especially important to complement current post-natal monitoring procedures as these may not be sensitive enough to detect damage that is already present but not yet symptomatic.
By Diego Gazzolo
Measuring certain brain constituents could be particularly useful for the early detection of cases of neural damage that could put a newborn at risk of short or long-term brain injury. In line with this, prominent European, US and international healthcare institutions have promoted perinatal clinical and experimental neuroprotection research projects, with the aim of validating a panel of biomarkers and subsequently integrating them into clinical guidelines.
According to a recent review published in Clinical Chemistry and Laboratory Medicine, although this is a promising step forward, there are several limitations preventing neural biomarkers from being included in standard monitoring procedures. These limiting factors include; the wide range of neurological complications that can occur in the perinatal period, the use of different techniques for the assessment of neural biomarkers, and a lack of consensus regarding the validation of assays in biological fluids, such as urine and saliva. Other issues relate to research practices, such as the use of small cohort sizes in scientific studies and a lack of multicenter investigations.
The review also provides an up-to-date overview of the most promising developments in the use of biomarkers during the perinatal period, and highlights candidate biomarkers, including calcium binding proteins (S100B protein), vasoactive agents (adrenomedullin), brain biomarkers (activin A, neuron specific enolase, glial fibrillary acidic protein, ubiquitin carboxyl-terminal hydrolase L1), and markers of oxidative stress. The authors conclude that “despite the limitations mentioned, we are not so far from reaching the target”.
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Iliana Bersani, Francesca Pluchinotta, Andrea Dotta, Immacolata Savarese, Francesca Campi, Cinzia Auriti, Natalia Chuklantseva, Fiammetta Piersigilli, Francesca Gazzolo, Alessandro Varrica, Angela Satriano and Diego Gazzolo: Early predictors of perinatal brain damage: the role of neurobiomarkers, 19.12.2019.