Glial fibrillary acidic protein as a biomarker for periventricular white matter injury

Amanda Stewart, Aylin Tekes, Thierry A.G.M. Huisman, Jacky M. Jennings, Marilee C. Allen, Frances J. Northington, Allen D. Everett, Ernest M. Graham

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


OBJECTIVE: Periventricular white matter injury (PWMI), a precursor of cerebral palsy, traditionally is not diagnosed until 6 weeks of life by head ultrasound scanning. We sought to determine whether early neonatal glial fibrillary acidic protein (GFAP) levels could identify PWMI in low birthweight (<2500 g) infants. STUDY DESIGN: Each case with PWMI on head ultrasound scanning at 6 weeks of life from April 2009 to April 2011 was matched by gestational age and mode of delivery to 2 subsequent neonates with a normal head ultrasound scan. GFAP was measured in cord blood at birth, at neonatal intensive care unit admission, and on days 1-4 of life. RESULTS: During this 2-year period, 21 cases with PWMI with gestational age 27.4 ± 3.3 weeks were compared with 42 control infants. The incidence of cesarean delivery was 61.9% in both groups. GFAP was not significantly different in cord blood or at neonatal intensive care unit admission but was significantly elevated on day 1 (median, 5-95%; 0, 0-0.98 ng/mL cases; 0, 0-0.06 ng/mL control infants; P=.03), day 2 (0, 0-1.21 ng/mL; 0, 0-0.05 ng/mL, respectively; P=.02), day 3 (0.05, 0-0.33 ng/mL; 0, 0-0.04 ng/mL, respectively; P = .004), and day 4 (0.02, 0-1.03 ng/mL; 0, 0-0.05 ng/mL, respectively; P < .001). The odds of the development ofPWMI significantly increased with increasing levels of GFAP from day 1-4 of life when adjustment was made for preeclampsia, antenatal steroid administration, and neonatal chronic lung disease. CONCLUSION: The ability to predict PWMI with a blood test for GFAP shortly after birth opens the possibility for rapid identification of infants for early intervention and provides a benchmark for the qualification of new therapies to improve neurodevelopmental outcomes.

Original languageEnglish (US)
Pages (from-to)27.e1-27.e7
JournalAmerican journal of obstetrics and gynecology
Issue number1
StatePublished - Jul 2013


  • Cerebral palsy
  • Glial fibrillary acidic protein
  • Periventricular white matter injury

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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