Blood neuronal specific enolase in newborns with perinatal asphyxia

Introduction. Neuron-specific enolase (NSE) is a sensitive marker of brain injury after hypoxia or ischemia. There are few studies about its usefulness in asphyctic newborns. Objective. To study the correlation between blood NSE levels and neurological outcome in newborns with hypoxic-ischemic encephalopathy. Patients and methods. We have determined the blood values of NSE by radioimmunoassay in 25 asphyctic term-newborns with clinical encephalopathy (of mild, moderate and severe degree) and in 22 healthy term-newborns (control group). Blood samples were obtained between 24 and 72 hours after birth in all neonates. Surviving infants were followed for a variable time (median: 3.5 years; ranger 1-6) and the neurological status was determined Results. NSE levels in the group of asphyctic neonates who died or developed neurological sequelae (n = 6: mean: 116.4 ng/ml; range: 42-226) were significantly higher than NSE values in the group of asphyctic neonates who were neurologically normal at follow-up (n = 19; mean: 21.3 ng/ml; range: 74-40), with p < 0.001. There were not differences between NSE values in the group of asphyctic neonates who developed neurologically normal and the control group (mean: 76 ng/ml; range: 10.3-28.3). Sensitivity and specificity of blood NSE as predictor of poor outcome were, respectively, 100% and 78%. The combined specificity for blood NSE together with a moderate/severe encephalopathy was 95%. Conclusions. The presence of elevated NSE values in blood after perinatal asphyxia can be a sensitive indicator of conspicuous brain damage. The combined information provided by the severity of the encephalopathy together with the blood NSE values have shown a high predictive value for neurological outcome.