Early Neonatal C-Reactive Protein Levels and Periventricular Leukomalacia

Background: Cystic periventricular leukomalacia (cPVL) is a strong indicator of subsequent motor and developmental impairments in premature infants. There is a paucity of, publications on biomarkers of cPVL. Objectives: To determine C-reactive protein (CRP) during the first week of life of preterm infants who later oped cPVL and to identify the association between CRP Nith perinatal factors. Methods: We retrospectively included infants 32 weeks ges tation and/or birth weights 4 1500 grams; 17 with a cranial ultrasound diagnosis of cPVL and 54 with normal ultrasounds. Serum CRP levels were measured during days 1-7 (CRP1-7d) of ife and subdivided into two timing groups: days 1-3 (CRP1-31 and days 4-7 (CRP4-7). Results: The cPVL group had significantly higher mean CRP4-7d evels compared to controls (12.75 +/- 21.2 vs. 2.23 +/- 3.1, re pectively, P= 0.03), while CRP1-3d levels were similar. CRP1- 4d levels were significantly correlated with maximal fraction of inspired oxygen during the first 12 hours of life (FiO(2)-12h, r= 0.51, P< 0.001). Additional risk factors were not associated with CRP levels. Conclusions: Our finding of elevated CRP4-7d levels and later development of cPVL supports earlier studies on the involvement of inflammation in the pathogenesis of cPVL. Whether CRP could serve as a biomarker of cPVL and its correlation ith outcomes, awaits further trials. Furthermore, thelion between FiO(2)-12h and CRP1-7d levels suggest that hypoxia and/or hyperoxia may serve as a trigger in the activation of inflammation during the first days of life of preterm infants.