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Article Abstract
Objective: Early detection of hypoxic-ischemic encephalopathy (HIE) in neonates is critical. We conducted a pilot cohort study to determine the feasibility of collecting umbilical cord blood samples for neurofilament light (NfL) and to assess the association of NfL with non-reassuring fetal status and other cord biomarkers. We aimed to address (1) Feasibility of cord NfL sample collection and analysis; (2) Association of NfL with non-reassuring fetal status (CTG changes and/or documented non-reassuring fetal status), neonatal intensive care unit (NICU) admission and length of stay; (3) Correlation of NfL with other cord biomarkers.
Methods: This was a prospective cohort study performed in a single, large tertiary and quaternary referral hospital. A total of 108 maternal participants consented to donate cord blood. Umbilical cord blood NfL levels were measured via single molecule array (Simoa) analysis.
Results: Cord NfL was higher in preterm neonates and was correlated with cord lactate, pH, and base excess. After controlling for mode of delivery and gestational age, NfL (odds ratio [OR] = 2.29, 95% confidence interval [CI]: 1.15-5.57), but not pH (OR = 0.78, 95% CI: 0.42-1.41), base excess (OR = 0.83, 95% CI: 0.37-1.86), or lactate (OR = 1.06, 95% CI: 0.51-2.12) was associated with non-reassuring fetal status. NfL levels were higher in neonates admitted to NICU (median [IQR]: 11.3 [7] vs 8.5 [5.1]).
Conclusion: Cord blood NfL analysis was feasible and provided correlates of adverse outcomes. Higher venous cord blood NfL levels were associated with non-reassuring fetal status. Further research is needed to validate these findings and establish the role of NfL, if any, in clinical practice.
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