Clinical significance of dynamic measurements of seric TNF-α, HMGBl, and NSE levels and aEEG monitoring in neonatal asphyxia.

OBJECTIVE: This study investigates the clinical value of monitoring blood levels of tumor necrosis factor-α (TNF-α), high mobility group protein Bl (HMGBl), and neuron-specific enolase (NSE), and examining an amplitude-integrated electroencephalogram (aEEG) for the diagnosis and short-term prognosis of brain damage caused by neonatal asphyxia.

PATIENTS AND METHODS: Sixty full-term neonates born in Yidu Central Hospital from January to December 2015 were enrolled in the study. The neonates were classified into one of 3 groups: 23 neonates in the mild asphyxia group, 7 in a severe asphyxia group and 30 in a control group admitted to the NICU but without asphyxia. The neonates presenting asphyxia received standard neonatal resuscitation before they were transferred to the NICU. The dynamic changes of the umbilical artery/peripheral blood TNF-α, HMGBl, and NSE levels and aEEG results were monitored and compared among the groups.

RESULTS: The umbilical artery and serum TNF-α, HMGBl, and NSE levels at day 1 were significantly higher in the two asphyxia groups than in the control group; and the values were higher in the severe asphyxia group (p <0.05). Furthermore, the correlation coefficients between TNF-α and HMGB1, TNF-α and NSE, and HMGB1 and NSE at all the monitoring time points were positive: 0.5516, 26.943 and 15.87, respectively (p <0.001). Additionally, the neonates with abnormal aEEG results at 6 hours postpartum had higher serum TNF-α, HMGBl and NSE levels than those with normal aEEG results (p <0.05). The patients with persistently abnormal or progressively deteriorating aEEG results usually had a poor evolution.

CONCLUSIONS: The dynamic monitoring of TNF-α, HMGBl, and NSE levels combined with aEEG can provide useful evidence for the early diagnosis, the determination of severity and the short-term prognosis of brain damage caused by neonatal asphyxia.