Glial fibrillary acidic protein as a serum neuromarker of brain injury in pediatric patients with congenital heart defects undergoing cardiac surgery

Objective: The aim of this study was to assess glial fibrillary acidic protein (GFAP) as a marker of short-term neurodevelopmental delay in pediatric patients with congenital defects (CHD) after cardiovascular surgical intervention.

Methods: Included patients were screened by Denver Developmental Screening Test II scale a few days before and then at 4 to 6 months after the surgical intervention. Blood samples were collected preoperatory and at 24 hours after surgery; GFAP levels were assessed by enzyme-linked immunosorbent assay using commercial kit form BioVendor.

Results: Forty children were enrolled and dichotomized into two groups based on peripheric oxygen saturation: cyanotic (<95%) and non-cyanotic (>=95%) group. 63% from our population had an abnormal neurodevelopmental outcome. Significant differences between groups were found in language domain scores preoperatory (p=0.03) and in fine motor domain postoperatory (p=0.03). In the postoperatory period, GFAP had significantly higher values (p=0.0248) in the cyanotic CHD group. Association between GFAP and NIRS were analyzed and significant differences were found in both groups with a good predicting model in the non-cyanotic CHD group (aria under curve of 0.7 for receiver operative characteristic). Higher GFAP levels from the postoperatory period correlated with neurodevelopmental impairment (mean value of: 0.66 ± 0.02ng/ml in those with good neurodevelopmental score, 0.69 ± 0.02ng/ml in those with low neurodevelopmental score, p=0.01).

Conclusions: GFAP could be a reliable neuromarker in identifying early acute brain injury documented by NIRS monitorization during perioperatory period and it also could identify short term neurodevelopmental impairment documented by lower neurodevelopmental scores.