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Title: Increased plasma concentrations of activin a predict intraventricular hemorrhage in preterm newborns.
Authors: Florio, Pasquale
Perrone, S
Luisi, Stefano
Vezzosi, P
Longini, Mariangela
Marzocchi, Barbara 
Petraglia, Felice
Buonocore, Giuseppe
Issue Date: 2006
Project: None 
Background: Intraventricular hemorrhage (IVH) is amajor cause of neurologic disabilities in preterm newborns.We evaluated the use of plasma activin A concentrationsto predict the development of perinatal IVH.Methods: We measured nucleated erythrocyte (NRBC)counts, plasma activin A, hypoxanthine (Hyp), andxanthine (Xan) in arterial blood samples obtained from53 preterm infants during the first hour after birth.Cerebral ultrasound was performed within 48 h of birthand repeated at 5- or 6-day intervals until the age of 4weeks.Results: Grade I or II IVH was detected during the first10 days of life in 11 of 53 patients (21%). Activin A, Hyp,and Xan concentrations and NRBC counts were higherin preterm newborns who subsequently developed IVHthan in those who did not (P <0.0001, except P 0.019for 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 whodeveloped 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 cutoffof 0.8 g/L activin A, the sensitivity and specificity were100% [11 of 11; 95% confidence interval (CI), 71%–100%]and 93% (39 of 42; 95% CI, 81%–98%), and positive andnegative predictive values were 79% (95% CI, 61%–100%) and 0% (95% CI, 0%–2%), respectively. The areaunder the ROC curve was 0.98.Conclusions: Activin A concentrations at birth are increasedin preterm newborns who later develop IVHand may be useful for early identification of infantswith hypoxic-ischemic brain insults who are at high riskfor IVH.
ISSN: 0009-9147
DOI: 10.1373/clinchem.2005.065979
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