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Increased Plasma Concentrations of Activin A Predict Intraventricular Hemorrhage in Preterm Newborns

Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.

^aAddress correspondence to this author at: Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte", V.le Bracci 36, 53100 Siena, Italy. Fax 39-0577-586182; e-mail buonocore{at}unisi.it.

Background: Intraventricular hemorrhage (IVH) is a major cause of neurologic disabilities in preterm newborns. We evaluated the use of plasma activin A concentrations to predict the development of perinatal IVH.

Methods: We measured nucleated erythrocyte (NRBC) counts, plasma activin A, hypoxanthine (Hyp), and xanthine (Xan) in arterial blood samples obtained from 53 preterm infants during the first hour after birth. Cerebral ultrasound was performed within 48 h of birth and repeated at 5- or 6-day intervals until the age of 4 weeks.

Results: Grade I or II IVH was detected during the first 10 days of life in 11 of 53 patients (21%). Activin A, Hyp, and Xan concentrations and NRBC counts were higher in preterm newborns who subsequently developed IVH than in those who did not (P <0.0001, except P = 0.019 for Xan). Neonatal activin A was correlated (P <0.0001) with Hyp (r = 0.95), Xan (r = 0.90), and NRBC count (r = 0.90) in newborns without later IVH and in those who developed IVH (Hyp, r = 0.89, P = 0.0002; Xan, r = 0.95, P <0.0001; NRBC count, r = 0.90, P = 0.0002). At a cutoff of 0.8 µg/L activin A, the sensitivity and specificity were 100% [11 of 11; 95% confidence interval (CI), 71%–100%] and 93% (39 of 42; 95% CI, 81%–98%), and positive and negative predictive values were 79% (95% CI, 61%–100%) and 0% (95% CI, 0%–2%), respectively. The area under the ROC curve was 0.98.

Conclusions: Activin A concentrations at birth are increased in preterm newborns who later develop IVH and may be useful for early identification of infants with hypoxic-ischemic brain insults who are at high risk for IVH.

The following articles in journals at HighWire Press have cited this article:

				P. Florio, R. Felipe Abella, T. de la Torre, A. Giamberti, S. Luisi, G. Butera, A. Cazzaniga, A. Frigiola, F. Petraglia, and D. Gazzolo Perioperative Activin A Concentrations as a Predictive Marker of Neurologic Abnormalities in Children after Open Heart Surgery Clin. Chem., May 1, 2007; 53(5): 982 - 985. [Abstract] [Full Text] [PDF]

				P. Florio, S. Luisi, B. Moataza, M. Torricelli, I. Iman, M. Hala, A. Hanna, F. Petraglia, and D. Gazzolo High Urinary Concentrations of Activin A in Asphyxiated Full-Term Newborns with Moderate or Severe Hypoxic Ischemic Encephalopathy Clin. Chem., March 1, 2007; 53(3): 520 - 522. [Abstract] [Full Text] [PDF]