Activin A is Not a Reliable Prognostic Biomarker For Bilirubin Induced Neurotoxicity in Neonates

Background: Bilirubin induced neurological dysfunction (BIND) remains an important cause of disability in developing countries. Although high total serum bilirubin (TSB) is the main instigator for BIND, different babies may have different neurological outcomes at the same TSB level. This reflects the need for a more specific predictive factor for the neurological outcome, which would allow prompt intervention and prevention of kernicterus. Aim of the Work: To assess the value of serum activin A as a predictor for acute bilirubin neurotoxicity and adverse neurodevelopmental outcomes at one year of life. Materials and Methods: The study enrolled 84 term/near-term infants admitted with indirect hyperbilirubinemia requiring intervention to the Neonatal Intensive Care Unit of Cairo University Children’s Hospital. Clinical examination, BIND score and laboratory tests including activin A were performed. Neurodevelopmental outcome was assessed at 3, 6 and 12 months using the Bayley scale of Infant Development II. Correlations between serum activin A, TSB, BIND scores and Bayley scores were studied. Results: Mean TSB level at admission was 25.92±7.14 mg/dL. BIND score at admission ranged from 0-7, and mean serum activin A level was 109.92±55 pg/ml. Activin A did not show significant correlations with TSB or BIND scores. A negative correlation between activin A level and psychomotor developmental index (PDI) at 3 months was detected however all other neurodevelopmental outcomes showed no significant correlation with activin A. Conclusion: In cases of neonatal hyperbilirubinemia, activin A is not a reliable biomarker for predicting acute or chronic bilirubin induced neurotoxicity