Cardiac troponin as biochemical marker of perinatal asphyxia and hypoxic myocardial injury

Abstract

Background/Aim. Myocardial cell lesion in newborns may be clinically occult. In recent years there has been shown growing interest in the use of cardiac troponin-I (cTnI) in relation to perinatal asphyxia and hypoxic myocardial lesion. The aim of this study was to determine a relationship between high cTnI levels and outcome in critically ill newborns with perinatal asphyxia. Methods. In this study 78 patients were divided into three groups. The group I included 39 newborns (15 term and 24 preterm) with perinatal asphyxia, with no deaths, only full or partial (with some neurological sequels) recovery. The group II included 10 newborns (6 preterm and 4 term), with perinatal asphyxia who died, with critical cardio-respiratory problems and multiorgan dysfunction. The group III included 29 healthy term newborns. A level of cTnI in all three groups was measured within 24-48 hours after delivery. Results. A statistically significant higher value of cTnI (0.082 ?g/l ? 0.166) was found in group I than in the group III (healthy newborns). In the group I, 21/39 newborns required respiratory and 16/39 required pressure support. In the group II, the largest average value of cTnI of 0.425 ? 0.307 was found. All of the newborns in the group II required respiratory and pressure support. In the group III the lowest average value of cTnI (0.0186 ?g/L ? 0.0286) was found. Conclusions. High cTnI levels could be used as markers of perinatal asphyxia and even as predictors of future outcomes and/or mortality.Uvod/Cilj. Postasfikticka lezija miokarda kod novorodjene dece moze biti klinicki neprimetna. Poslednjih godina raste interesovanje za primenu srcanog troponina I (cTnI), u proceni perinatalne asfiksije i hipoksicke lezije miokarda. Cilj ove studije bio je da se utvrdi povezanost ranog porasta nivoa cTnI sa krajnjim ishodom kod vitalno ugrozene asfikticne novorodjencadi. Metode. Prospektivnom studijom bilo je obuhvaceno 78 ispitanika podeljenih u III grupe. Grupa I obuhvatala je 39 novorodjencadi (24 prevremeno rodjenih i 15 u terminu) sa dijagnozom perinatalne asfiksije i kompletnim oporavkom ili sa neuroloskim sekvelama, ali bez smrtnog ishoda. Grupa II obuhvatala je 10 novorodjencadi (6 prevremeno rodjenih i 4 u terminu) sa dijagnozom perinatalne asfiksije pracene teskom kardiorespiratornom insuficijencijom ili multiorganskom disfunkcijom (3 ili vise organa) i obaveznim smrtnim ishodom. Grupa III obuhvatala je 29 zdrave, terminske novorodjencadi. Svim ispitanicima odredjen je nivo cTnI u serumu tokom prva 24-48 h po rodjenju. Rezultati. U grupi I zabelezena je statisticki znatno visa srednja vrednost cTnI (0,082 ? 0,166 ?g/l) u odnosu na grupu III (zdrava novorodjencad). U grupi I primenu inotropa zahtevalo je 16/39, a primenu konvencionalne ventilacije 21/39 novorodjencadi. U grupi II zabelezena je najvisa srednja vrednost cTnI od 0,425 ? 0,307 ?g/L, a svi ispitanici zahtevali su primenu konvencionalne ventilacije i inotropa. U grupi III zabelezena je najniza srednja vrednost cTnI (0,0186 ? 0,0286 ?g/L). Zakljucak. Porast nivoa cTnI u serumu mogao bi da se koristi kao marker perinatalne asfiksije i prediktor eventualnih posledica i/ili smrtnog ishoda.