Umbilical Cord Blood Test Could Identify Preterm Infants at Risk for Medical Complications

Advancements in medical technology and neonatology have significantly improved the care of prematurely born infants. However, these infants still face heightened risks for medical complications, such as invasive infections and sepsis, many of which current diagnostic tools fail to predict accurately or in real time. A deeper understanding of the pathophysiology and the developmental state of preterm infants, from both a biological and molecular perspective, could not only help in sustaining their lives but also in optimizing their health outcomes more precisely. In a study published in Scientific Reports, researchers have uncovered how proteins present in umbilical cord blood at birth evolve during gestational development, offering potential biomarkers for new precision care strategies for premature infants.

To explore the biological status of premature babies compared to those born at full term, scientists from Northwestern Medicine (Evanston, IL, USA) analyzed umbilical cord blood samples from 150 infants born between 25 and 42 weeks of gestation at Northwestern Prentice Women’s Hospital from 2008 to 2019. Umbilical cord blood provides a unique insight into the fetus’s condition at birth, distinct from standard blood samples. Using mass spectrometry-based proteomics techniques, the researchers mapped the proteome, or the set of expressed proteins, in the cord blood samples. They found that the abundance of various proteins changed according to gestational age.

For instance, proteins that aid in structural development and growth—such as those involved in extracellular matrix organization, lipid particle remodeling, and blood vessel development—were found in greater quantities earlier in gestation. In contrast, proteins involved in immune responses and inflammatory signaling pathways, including complements and calcium-binding proteins, were more highly expressed later in gestation. This shift reflects how proteins functioning in the immune system evolve over the course of pregnancy, which can assist clinicians in understanding the deficiencies in infants born prematurely, especially when compared to full-term infants’ immune status.

These biomarkers could provide critical insights into why premature infants are more prone to infections, brain bleeds, and other complications related to early birth. With this knowledge, clinicians could develop more targeted care strategies and treatment approaches. Future steps in this research involve validating these biomarkers to improve the timely and accurate diagnosis of early-onset sepsis in newborns. Such biomarkers may also help determine which infants would benefit from antibiotic treatment and which could be spared from unnecessary antibiotics, instead receiving alternative treatments better suited to their needs.

“If we understand what’s lacking in babies that are born early, we can use that information to develop therapeutic interventions to mediate those differences and to optimize the environment and clinical state of those babies,” said Leena Mithal, associate professor of Pediatrics in the Division of Infectious Diseases and lead author of the study. “The goal is a cord blood diagnostic test at the time of birth to help us risk stratify for early-onset infection and provide a precision medicine approach to targeted antibiotic therapy.”