Abstract 73

Background: Glial fibrillary acid protein (GFAP) is a protein produced specified by astrocytes. Neurofilament protein (NFP) is a protein produced in axons. S100 is a calcium protein protein produced in astrocytes. We studied these proteins in the CSF of preterm infants with post-haemorrhagic ventricular dilatation (PHVD).

Methods: Ventricular cerebrospinal fluid (CSF) was analysed from 18 preterm infants with PHVD aged 2-6-weeks. GFAP, NFP and S100 protein were measured using immunoassay techniques we have previously validated. The grade of IVH, whether or not the infant was discharged from hospital with a ventriculoperitoneal shunt or died with uncontrolled hydrocephalus was determined before analysis as was the neurodevelopmental status of survivors.

Results. GFAP (median + Cl) 84663 ng/l (36492-286761). S100 (median + Cl) 6.41 microg/l (5.08-13.57). NFP (median + range) 9229 ng/l (713 - 168,000). These values are approximately 30 to 100 times higher than controls. GFAP, NFP and S100 all showed significant correlations (p = 0.0018, 0.497, 0.0078 respectively) with worsening neurodevelopmental outcome but none of the proteins correlated with grade of IVH or shunt dependence.

Conclusions: These extremely high concentrations of markers for astroglial, oligodendroglial and axonal change shows that PHVD is associated with damage to preventricular white matter even in infants without parenchymal lesions on ultrasound and who do not need shunt surgery. GFAP in CSF was highly predictive of outcome.