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levated levels of S100B protein are a well-established marker of central nervous system (CNS) damage. Fetal anemia resulting from hemolytic disease of the fetus and newborn (HDFN) often necessitates intrauterine transfusions (IUTs) and represents a significant risk factor for CNS injury. However, it remains uncertain whether S100B protein levels can reliably predict which fetuses are at higher risk for CNS complications in this context. Furthermore, the potential role of measuring S100B concentrations before IUT in prenatal assessments, and its relationship to the severity of anemia and fetal cerebral blood flow, remains poorly understood. This study aims to investigate the concentration of S100B protein in cord blood from newborns with HDFN-related fetal anemia requiring IUT. The study group comprises pregnancies complicated by HDFN with abnormal middle cerebral artery (MCA) blood flow, indicating the need for IUT. In this group, S100B protein levels will be measured before each IUT, with additional measurements if further transfusions are required. The control group consists of pregnancies with HDFN that do not require IUT. Cord blood samples will be collected at birth to evaluate S100B protein levels in both groups. Additionally, fetal MCA blood flow will be monitored, and in the study group, fetal hemoglobin and hematocrit levels will be assessed before each IUT. The primary endpoints of the study include the measurement of cord blood S100B protein levels before IUT in the study group and at birth in both groups. Secondary endpoints will explore the potential correlations between S100B protein levels and umbilical cord blood gas parameters (e.g., pH, BE, lactate), fetal cerebral blood flow parameters (e.g., MCA-PSV values), and blood count parameters (e.g., hemoglobin and hematocrit levels), both before IUT in the study group and after birth in both groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study group | Pregnant women with HDFN-related fetal anemia requiring intrauterine transfusion (IUT). The need for IUT is determined based on prenatal ultrasound assessment of the peak systolic velocity in the middle cerebral artery (MCA-PSV), expressed as multiples of the median (MoM). A MoM value greater than 1.5 is indicative of severe fetal anemia and serves as the primary criterion for IUT. |
| |
| Control group | Women with pregnancies complicated by HDFN who do not meet the criteria for intrauterine transfusion (IUT). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cord blood S100B protein level prior to IUT | Diagnostic Test | One milliliter of cord blood will be collected before each IUT procedure to measure S100B protein concentration. The sample will be labeled with the mother's name, date of birth, collection date, and IUT indication, then sent to the laboratory for centrifugation. |
| Measure | Description | Time Frame |
|---|---|---|
| Cord blood S100B protein concentration | Cord blood S100B protein concentration, measured both before the IUT in the study group and from umbilical cord blood samples collected after birth in both the study and control groups. | Within 3 months of enrollment |
| Measure | Description | Time Frame |
|---|---|---|
| Correlation of cord blood S100B concentration with pH, BE, and lactate levels in cord blood gas analysis | The correlation between cord blood S100B protein concentration and pH, BE, and lactate levels, measured before the IUT in the study group and from umbilical cord blood samples collected after birth in both the study and control groups. | Within 3 months of enrollment |
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Study Group - Inclusion Criteria:
Study Group - Exclusion Criteria:
1. Maternal chronic use of selective serotonin reuptake inhibitors (SSRIs).
Control Group - Inclusion Criteria:
Control Group - Exclusion Criteria:
1. Maternal chronic use of selective serotonin reuptake inhibitors (SSRIs).
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Pregnant women diagnosed with hemolytic disease of the fetus and newborn (HDFN).
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Agnieszka A. Drozdowska-Szymczak, MD, PhD | Contact | +48 22 32 77 411 | agnieszka.drozdowska@imid.med.pl | |
| Sabina A. Łukawska, MD | Contact | +48 691 235 077 | sabina.lukawska@imid.med.pl |
| Name | Affiliation | Role |
|---|---|---|
| Agnieszka A. Drozdowska-Szymczak, MD, PhD | Institute of Mother and Child in Warsaw, Poland | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Institute of Mother and Child | Recruiting | Warsaw | 01-211 | Poland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28503958 | Background | Ree IMC, Smits-Wintjens VEHJ, van der Bom JG, van Klink JMM, Oepkes D, Lopriore E. Neonatal management and outcome in alloimmune hemolytic disease. Expert Rev Hematol. 2017 Jul;10(7):607-616. doi: 10.1080/17474086.2017.1331124. Epub 2017 Jun 5. | |
| 22030316 | Background | Lindenburg IT, Smits-Wintjens VE, van Klink JM, Verduin E, van Kamp IL, Walther FJ, Schonewille H, Doxiadis II, Kanhai HH, van Lith JM, van Zwet EW, Oepkes D, Brand A, Lopriore E; LOTUS study group. Long-term neurodevelopmental outcome after intrauterine transfusion for hemolytic disease of the fetus/newborn: the LOTUS study. Am J Obstet Gynecol. 2012 Feb;206(2):141.e1-8. doi: 10.1016/j.ajog.2011.09.024. Epub 2011 Sep 24. |
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serum and whole blood samples
|
| Umbilical cord blood gas analysis prior to IUT | Diagnostic Test | Half a milliliter of cord blood will be collected before each IUT procedure for immediate umbilical cord blood gas analysis, including pH, base excess (BE), and lactate levels. |
|
| Fetal blood count evaluation prior to IUT | Diagnostic Test | Fetal blood count data, including hemoglobin and hematocrit levels, will be collected before each IUT procedure. |
|
| Cord blood S100B protein concentration at birth | Diagnostic Test | After delivery, one milliliter of blood will be collected from the severed umbilical cord to measure the concentration of S100B protein. The sample will be labeled with the mother's name, the child's birth date and sex, and the collection date, before being sent to the laboratory for centrifugation. |
|
| Umbilical cord blood gas analysis at birth | Diagnostic Test | After birth, 0.5 mL of blood will be collected from the severed umbilical cord to assess pH, base excess (BE), and lactate levels in an umbilical cord blood gas analysis. |
|
| Complete blood count after birth | Diagnostic Test | Complete blood count parameters, including hematocrit (Hct) and hemoglobin (Hgb) concentrations, will be measured within six hours after birth. |
|
| Ultrasound evaluation of fetal blood flow | Diagnostic Test | Fetal cerebral blood flow will be routinely assessed via ultrasound, including measurements of MCA-PSV values. |
|
| Neonatal transfontanelle ultrasound assessment | Diagnostic Test | A transfontanelle ultrasound examination will. be performed to assess for any abnormalities in the newborn. |
|
| Complete blood count analysis in cord blood at birth | Diagnostic Test | Complete blood count parameters, including hematocrit (Hct) and hemoglobin (Hgb) concentrations, will be measured in cord blood samples collected at birth. |
|
| Association between cord blood S100B protein concentration and complete blood count parameters | The relationship between cord blood S100B protein concentration and Hgb and Hct levels, measured from cord blood samples collected before IUT in the study group, as well as from cord blood at birth and venous blood within the first six hours of life in both groups. | Within 3 months of enrollment |
| Correlation between cord blood S100B protein concentration and MCA-PSV values | The association between cord blood S100B protein concentration and MCA-PSV values determined via fetal ultrasound. | Within 3 months of enrollment |
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| ID | Term |
|---|---|
| D020925 | Hypoxia-Ischemia, Brain |
| D004899 | Erythroblastosis, Fetal |
| ID | Term |
|---|---|
| D002545 | Brain Ischemia |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D002534 | Hypoxia, Brain |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D000860 | Hypoxia |
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D005315 | Fetal Diseases |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007232 | Infant, Newborn, Diseases |
| D007154 | Immune System Diseases |
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