Targeted Metabolic Profiling of Preterm Neonates with Intraventricular Hemorrhage

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Abstract
Background: Intraventricular hemorrhage (IVH) is a major cause of morbidity and mortality in preterm neonates. It is essential to obtain new biomarkers for its early diagnosis. This can mainly occur by understanding its pathophysiology and mechanism of occurrence. Objective: To investigate the metabolic changes (blood amino acids and carnitine concentrations) associated with IVH in preterm neonates, and the ability to discover new biomarkers for early diagnosis of such disease that enable early intervention. Patients and Methods: This study was conducted on twenty preterm infants with IVH in the period from July 2019 to July 2020. Preterm infants were evaluated for IVH according to Velisavljev-Fillpoviewith head US scans performed within 24 h after birth, on the 3rd day of life and thereafter weekly till discharge in survivors (Cases). Twenty preterm infants were chosen as a control group matching with the case group in gestational age, gender, and birth weight. Results: There was significant rise of alanine, aspartate, glutamate, and ornithine amino acids in IVH group than control in day 1 (P value < 0.05) in addition to glycine, valine, and proline in day 3. Alanine amino acid > 112.5 μmol/L showed the highest accuracy 80%, sensitivity 70% and specificity 90% for diagnosis of IVH in premature neonates among all tested amino acids in day 1with significant rise in C3:C2 at cut off point 0.095 (p= 0.001) and C6 cut off point 0.08 (P=0.001) and acylcarnitine cut off point >0.045 μmol/L (P=0.002) for diagnosis of IVH. Conclusion: Preterm neonates with IVH showed significant changes in amino acids and carnitines that might guide us to new biomarkers for early diagnosis and intervention.

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