Periventricular white matter injury (PWMI), a precursor of cerebral palsy, is traditionally not diagnosed until 6 weeks of life by head ultrasound. We sought to determine if early neonatal glial fibrillary acidic protein (GFAP) levels could identify PWMI in low birth weight (< 2500 grams) infants.
Each case with PWMI on head ultrasound at 6 weeks from 4/09-4/11 was matched by gestational age and mode of delivery to 2 subsequent neonates with a normal head ultrasound. GFAP was measured in cord blood at birth, at neonatal intensive care unit (NICU) admission, and daily on days 1–4 of life.
During this 2 year period, 21 cases with PWMI with gestational age 27.4±3.3 weeks were compared to 42 controls. The incidence of cesarean delivery was 61.9% in both groups. GFAP was not significantly different in cord blood or at NICU admission, but was significantly elevated on day 1 (median, 5%–95%; 0, 0–0.98 ng/mL cases; 0,0–0.06 ng/mL controls, P=0.03), day 2 (0, 0–1.21 ng/mL; 0, 0–0.05 ng/mL; P=0.02), day 3 (0.05, 0–0.33 ng/mL; 0, 0–0.04 ng/mL, P=0.004) and day 4 (0.02, 0–1.03 ng/mL; 0, 0–0.05 ng/mL, P<0.001). The odds of developing PWMI significantly increased with increasing levels of GFAP from day 1 to day 4 of life adjusting for preeclampsia, antenatal steroid administration and neonatal chronic lung disease.
The ability to predict PWMI with a blood test for GFAP shortly after birth opens the possibility for rapid identification of infants for early intervention and provides a benchmark for qualifying new therapies to improve neurodevelopmental outcomes.