Perioperative Glial Fibrillary Acidic Protein Is Associated with Long-Term Neurodevelopment Outcome of Infants with Congenital Heart Disease
Michela Vergine,
Luca Vedovelli,
Manuela Simonato,
Valentina Tonazzo,
Alessio Correani,
Elisa Cainelli,
Dario Gregori,
Massimo A. Padalino,
Paola Cogo
Affiliations
Michela Vergine
Division of Pediatrics, Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
Luca Vedovelli
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131 Padova, Italy
Manuela Simonato
PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica, “Citta’ della Speranza”, Corso Stati Uniti, 4F, 35127 Padova, Italy
Valentina Tonazzo
Department of Women’s and Children’s Health, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy
Alessio Correani
Division of Neonatology, Polytechnic University of Marche and “G. Salesi” Children’s Hospital, Via Corridoni, 11, 60123 Ancona, Italy
Elisa Cainelli
Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy
Dario Gregori
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131 Padova, Italy
Massimo A. Padalino
Pediatric and Congenital Cardiac Surgery, Department of Cardiac-Thoracic-Vascular Sciences and Publich Health, University of Padova, Via Giustiniani, 2-35128 Padova, Italy
Paola Cogo
Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
Background: Brain injury, impaired brain maturation, and long-term neurodevelopmental disorders are common in infants with congenital heart diseases (CHD). We aimed to assess whether plasma glial fibrillary acidic protein (GFAP) can predict neurodevelopmental anomalies in CHD infants operated on cardiopulmonary bypass (CPB). Methods: We measured plasma GFAP in 38 infants at multiple CPB phases. Cognitive, neuropsychological, and psychopathological functioning were assessed 5.7 ± 2.2 years after surgery. We identified an impaired global neurodevelopmental index (NDI) when at least two domains were abnormal. The relationships between NDI, GFAP, and clinical variables were explored with non-supervised feature selection methods and modeled with a nested non-linear logistic regression. Results: Intelligence quotient scores were within the normal range in 84% of children, whereas 58% showed an abnormal NDI, with the greatest impairments in the psychopathological area. The plasma GFAP peak was 0.95 (0.44–1.57) ng/mL, and it was correlated with age, weight, duration of surgery phases, and CPB minimum temperature. In the regression model, the GFAP peak was associated with an impaired NDI with a possible flexible point toward NDI impairment at 0.49 ng/mL, keeping constant ICU stay, CPB duration, CHD anatomy, weight, and CPB minimum temperature. Conclusion: GFAP is a promising early marker of abnormal long-term neuropsychological development.
