Diagnostic and prognostic value of markers UCH-L1 and NEFL for brain injury in premature infants

Preterm birth is a significant risk factor for central nervous system damage. The use of biomarkers in neonatal clinical practice may help to reduce the need for multiple invasive procedures and enable timely treatment and early preventive interventions. UCH-L1 is a neuron-specific enzyme that indicates acute neuronal injury, while NEFL is a peptide reflecting axonal damage that correlates with long-term neurological outcomes. The application of these biomarkers has the potential to optimize the management of preterm infants and improve prognostic accuracy. Aim - to determine the diagnostic and prognostic value of serum UCH-L1 and NEFL levels in preterm infants with brain injury. Materials and methods. The study included 69 newborns, divided into three groups: group 1 (n=20): preterm infants with sepsis and brain injury; group 2 (n=25): preterm infants with hypoxic-ischemic brain injury; control group (n=24): healthy full-term newborns. Serum levels of UCH-L1 and NEFL were measured in all participants using enzyme-linked immunosorbent assay. Sensitivity, specificity, and cut-off values of the biomarkers were assessed using ROC analysis. Results. The neonatal period was significantly more complicated in the group 1 infants. Neurological status in the both groups was characterized by brain edema, intraventricular hemorrhage, and seizures, with a significantly higher prevalence in the group 1. Blood levels of UCH-L1 and NEFL in the groups 1 and 2 were significantly higher than in the control group. ROC analysis confirmed a high diagnostic potential of UCH-L1 in identifying brain injury in preterm infants. An optimal cut-off value of UCH-L1 (112.65 pg/mL) demonstrated high sensitivity (94.7%) and specificity (85.7%) for diagnosing brain injury in preterm newborns. NEFL showed the highest accuracy in detecting severe brain injury. Conclusions. UCH-L1 is a highly sensitive biomarker for the early diagnosis of brain injury in preterm infants. NEFL may serve as an additional marker, particularly useful for identifying severe forms of brain injury. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from patients (parents of children or their guardians). The author declares no conflict of interest.