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Mondal T, Ryan PM, Gupta K, Radovanovic G, Pugh E, Chan AKC, Hill S. Cord-Blood High-Sensitivity Troponin-I Reference Interval and Association with Early Neonatal Outcomes. Am J Perinatol 2022; 29:1548-1554. [PMID: 33548938 DOI: 10.1055/s-0041-1722944] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study was aimed to establish a reference interval for high-sensitivity cardiac troponin I (hs-cTnI) in umbilical cord blood of infants and to assess its association with the risk of predetermined early neonatal outcomes in a high-acuity tertiary care hospital. STUDY DESIGN Umbilical cord-blood samples were collected and hs-cTnI was measured in all infants born between August 2015 and September 2015 at McMaster Children's Hospital (n = 256). Gestational age, birth weight, Apgar's scores, age in days at which feeding was established, neonatal intensive care unit (NICU) admission, and discharge in days after birth were recorded. RESULTS The 90th, 95th, and 99th percentiles for the term infant subcohort were 19.75, 41.45, and 166.30 ng/L, respectively. We observed decreased mean gestational ages and birth weights in both the 90th (37.7 weeks; 2,961.4 g) and 95th percentiles (37.1 weeks; 2,709.9 g) when compared with the remaining infants. Moreover, levels of hs-cTnI were significantly higher in infants with respiratory distress requiring intervention (p < 0.05), low birth weight infants (p < 0.01), preterm infants (p < 0.001), and those requiring NICU admission (p < 0.01). Multiple linear regression of the recorded demographic factors revealed prematurity (gestational age <35 weeks: coefficient 0.346 ± 0.160, p < 0.05; gestational age <37 weeks: coefficient 0.253 ± 0.105, p < 0.05) and male sex (coefficient 0.138 ± 0.047; p < 0.01) to be most predictive of log-hs-cTnI levels. CONCLUSION This study establishes the reference values for cord-blood hs-cTnI in infants at a tertiary care center. Premature and sick infants requiring NICU admission had significantly higher levels of hs-cTnI. KEY POINTS · Established the 90th, 95th, and 99th percentiles of neonatal cord-blood hs-cTnI in term infants as 19.75, 41.45, and 166.30 ng/L, respectively.. · Infants with hs-cTnI levels exceeding the 90th percentile had lower gestational ages and birth weights with higher rates of NICU admissions.. · Infants with respiratory distress or requiring NICU admission were found to have higher levels of hs-cTnI..
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Affiliation(s)
- Tapas Mondal
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Paul M Ryan
- Brookfield School of Medicine and Health Sciences, University College Cork, Cork, Ireland
| | - Kaaran Gupta
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - George Radovanovic
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Edward Pugh
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Stephen Hill
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.,Laboratory Medicine, Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada
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Iribarren I, Hilario E, Álvarez A, Alonso-Alconada D. Neonatal multiple organ failure after perinatal asphyxia. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:280.e1-280.e8. [PMID: 36115781 DOI: 10.1016/j.anpede.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Perinatal asphyxia is an event with far-reaching consequences that can lead not only to the development of neonatal encephalopathy, but also to multiple organ failure (MOF). This ailment may result from the redistribution of blood flow, which would preserve the perfusion of vital organs such as the heart, brain and adrenal glands at the expense of other organs. The objective of the study was to determine the incidence and aetiopathogenesis of failure in the organs most frequently involved in neonatal MOF following perinatal asphyxia. We conducted a systematic literature search in the PubMed, Scopus and Cochrane Library databases using the MeSH terms (ischemia AND hypoxia AND multiorgan dysfunction AND neonat*), (asphyxia AND multiorgan dysfunction AND neonat*) and (liver/kidney/digestive OR gastrointestinal/heart injury AND ischemia AND hypoxia AND neonat*). We selected clinical and preclinical studies published after 2000 and excluded case series, letters to the editor, cohort studies without comparison groups and abstracts. In this study, we found that MOF associated with perinatal asphyxia is a frequent phenomenon with a relevant impact on neonatal morbidity and mortality, as it can cause changes not only in the kidney, liver and gastrointestinal tract, but also cardiomyopathy if the ailment is protracted or severe.
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Affiliation(s)
- Isabel Iribarren
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain
| | - Enrique Hilario
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain
| | - Antonia Álvarez
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain
| | - Daniel Alonso-Alconada
- Departamento de Biología Celular e Histología, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Bizkaia, Spain.
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3
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Fallo multiorgánico neonatal tras asfixia perinatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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4
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Lespay-Rebolledo C, Perez-Lobos R, Tapia-Bustos A, Vio V, Morales P, Herrera-Marschitz M. Regionally Impaired Redox Homeostasis in the Brain of Rats Subjected to Global Perinatal Asphyxia: Sustained Effect up to 14 Postnatal Days. Neurotox Res 2018; 34:660-676. [PMID: 29959728 DOI: 10.1007/s12640-018-9928-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/30/2022]
Abstract
The present report evaluates the effect of global perinatal asphyxia on several parameters of oxidative stress and cell viability in rat brain tissue sampled at an extended neonatal period up to 14 days, a period characterised by intensive neuritogenesis, synaptogenesis, synaptic consolidation, pruning and delayed cell death. Perinatal asphyxia was induced by immersing foetus-containing uterine horns removed by a caesarean section from on term rat dams into a water bath at 37 °C for 21 min. Asphyxia-exposed and sibling caesarean-delivered foetuses were manually resucitated and nurtured by surrogate dams for 1 to 14 postnatal (P) days. Brain samples (mesencephalon, telencephalon and hippocampus) were assayed for glutathione (reduced and oxidated levels; spectrophotometry), tissue reducing capacity (potassium ferricyanide reducing assay, FRAP), catalase (the key enzyme protecting against oxidative stress and reactive oxygen species, Western blots and ELISA) and cleaved caspase-3 (the key executioner of apoptosis, Western blots) levels. It was found that global PA produced a regionally specific and sustained increase in GSSG/GSH ratio, a regionally specific decrease in tissue reducing capacity and a regionally and time specific decrease of catalase activity and increase of cleaved caspase-3 levels. The present study provides evidence for regionally impaired redox homeostasis in the brain of rats subjected to global PA, an effect observed up to P14, mainly affecting mesencephalon and hippocampus, suggesting a sustained oxidative stress after the posthypoxia period. The oxidative stress observed postnatally can in part be associated to a respiratory apneic-like deficit, since there was a statistically significant decrease in respiration frequency in AS compared to CS neonates, also up to P14, together with the signs of a decreased peripheral blood perfusion (pink-blue skin colour in AS, compared to the pink colour observed in all CS neonates). It is proposed that PA implies a long-term metabolic insult, triggered by the length of hypoxia, the resuscitation/reoxigenation manoevres, but also by the developmental stage of the affected brain regions, and the integrity of cardiovascular and respiratory physiological functions, which are fundamental for warrantying a proper development.
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Affiliation(s)
- Carolyne Lespay-Rebolledo
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - Ronald Perez-Lobos
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - Andrea Tapia-Bustos
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - Valentina Vio
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
| | - Paola Morales
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile
- Department Neuroscience, Medical Faculty, University of Chile, Santiago, Chile
| | - Mario Herrera-Marschitz
- Programme of Molecular & Clinical Pharmacology, ICBM, Medical Faculty, University of Chile, Av. Independencia 1027, PO Box 8389100, Santiago, Chile.
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Neves AL, Henriques-Coelho T, Leite-Moreira A, Areias JC. Cardiac injury biomarkers in paediatric age: Are we there yet? Heart Fail Rev 2018; 21:771-781. [PMID: 27255332 DOI: 10.1007/s10741-016-9567-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed access to MEDLINE citations; http://www.ncbi.nlm.nih.gov/PubMed/ ). The search strategy included the following medical subject headings and text terms for the key words: "cardiac injury biomarkers", "creatine kinase-MB", "myoglobin", "troponin", "children", "neonate/s", "newborn/s", "infant/s" and echocardiography. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication and can be used as predictors of subsequent cardiac recovery and mortality. Elevation of cardiac injury biomarkers may also have diagnostic value in cases when cardiac contusion or pericarditis is suspected. Cardiac injury biomarkers are very sensitive markers for the detection of myocardial injury and have been studied in healthy newborns, after tocolysis, intrauterine growth restriction, respiratory distress and asphyxia. The proportion of newborns with elevated troponin was higher than that in ill infants, children, and adolescents and in healthy adults, suggesting that myocardial injury, although clinically occult, is common in this young age group. Results suggest that significant elevation of cord troponin is an excellent early predictor of severity of hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac biomarkers may also benefit centres without on-site echocardiography with evidence showing good correlation with echo-derived markers of myocardial function. Further studies are needed to better clarify the role of cardiac biomarkers in paediatric age and their correlation with echocardiographic parameters.
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Affiliation(s)
- Ana L Neves
- Department of Paediatric Cardiology, São João Hospital, Porto, Portugal. .,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal. .,Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Tiago Henriques-Coelho
- Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Paediatric Surgery, São João Hospital, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, São João Hospital, Porto, Portugal
| | - José C Areias
- Department of Paediatric Cardiology, São João Hospital, Porto, Portugal.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
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6
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Controversies in the identification and management of acute pulmonary hypertension in preterm neonates. Pediatr Res 2017; 82:901-914. [PMID: 28820870 DOI: 10.1038/pr.2017.200] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/05/2017] [Indexed: 12/22/2022]
Abstract
It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation, and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations, and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute hypoxemic respiratory failure in the preterm neonate, outline the pathophysiological conditions that may present as acute PH, and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system. Although PVR and respiratory management are highly interrelated, there may be a population of preterm neonates in whom inhaled nitric oxide may improve illness severity and may relate to outcomes. A management approach based on physiology that considers common clinical conundrums is provided. A more comprehensive understanding of the physiology may help in informed decision-making in clinical situations where conclusive scientific evidence is lacking. Regardless, high-quality research is required, and appropriate definition of the target population is paramount. A thoughtful approach to cardiovascular therapy may also provide an avenue to improve neurodevelopmental outcomes while awaiting more clear answers.
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7
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Propofol administration to the fetal-maternal unit reduces cardiac oxidative stress in preterm lambs subjected to prenatal asphyxia and cardiac arrest. Pediatr Res 2016; 79:748-53. [PMID: 26761124 DOI: 10.1038/pr.2016.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the effects of propofol on oxidative stress and its effect on key structures of the contractile apparatus as the myosin light chain 2 (MLC2) and the p38MAPK survival pathway in the preterm heart. We hypothesized that propofol administration could attenuate the hypoxic myocardial injury after birth asphyxia. METHODS Pregnant ewes were randomized to receive either propofol or isoflurane anesthesia. A total of 44 late-preterm lambs were subjected to in utero umbilical cord occlusion (UCO), resulting in asphyxia and cardiac arrest, or sham treatment. After emergency cesarean delivery, each fetus was resuscitated, mechanically ventilated, and supported under anesthesia for 8 h using the same anesthetic as the one received by its mother. RESULTS At 8 h after UCO, occurrence of reactive oxygen species and activation of inducible nitric oxide synthase in the heart were lower in association with propofol anesthesia than with isoflurane. This was accompanied by less degradation of MLC2 but higher p38MAPK level and in echocardiography with a trend toward a higher median left ventricular fractional shortening. CONCLUSION The use of propofol resulted in less oxidative stress and was associated with less cytoskeletal damage of the contractile apparatus than the use of isoflurane anesthesia.
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8
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Liu Q, Yin ZQ, Ke N, Chen L, Chen XK, Fang J, Chen XR, Xiao J, Hu K, Zhang X, Xiong Y, Shi H, Li J, Long HJ, Zhang KL, Chen ZY, Pi LH. Incidence of retinopathy of prematurity in southwestern China and analysis of risk factors. Med Sci Monit 2014; 20:1442-51. [PMID: 25124335 PMCID: PMC4144944 DOI: 10.12659/msm.890688] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to screen for retinopathy of prematurity (ROP) in southwestern China and understand the prevalence and risk factors of ROP, which may provide evidence useful in the prevention and treatment of ROP. Material/Methods 1864 preterm infants (gestational age of <37 weeks and birth weight of ≤2500 g) underwent ROP screening from January 2009 to November 2012 in Southwest China. The medical information of infants during perinatal period was reviewed, and risk factors of ROP were determined. A total of 1614 infants were recruited for final analysis. Results Incidence of ROP was 12.8%. The first, second, third, and fourth stage of ROP was found in 64.6%, 29.6%, 3.4%, and 0.5% of infants, respectively. No fifth stage of ROP was observed. In addition, 7.7% of infants required surgical intervention. In our Department of Neonatology, the incidence of ROP was 20.0%, which was significantly higher than in non-hospitalized patients (9.9%). The incidence of ROP remained unchanged over the years. Independent risk factors of ROP included low birth weight (p=0.049), low gestational age (p=0.008), days of oxygen supplementation (p=0.008), and myocardial injury after birth (p=0.001). Conclusions The prevalence of ROP in preterm infants is relatively high in Southwest China, and low birth weight, low gestational age, days of oxygen supplementation, and myocardial injury after birth are independent risk factors for ROP.
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Affiliation(s)
- Qing Liu
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Zheng-Qin Yin
- Department of Ophthalmology, Southwest Hospital, Third Military Medical University, Chongqing, China (mainland)
| | - Ning Ke
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Lin Chen
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Xin-Ke Chen
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Jing Fang
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Xiu-Rong Chen
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Jun Xiao
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Kang Hu
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Xuan Zhang
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Yan Xiong
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Hui Shi
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Jie Li
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Hong-Jian Long
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Kang-Lin Zhang
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Zhi-Yu Chen
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
| | - Lian-Hong Pi
- Department of Ophthalmology, Children's Hospital, Chongqing Medical University, Chongqing, China (mainland)
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9
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Seehase M, Houthuizen P, Jellema RK, Collins JJP, Bekers O, Breuer J, Kramer BW. Propofol administration to the fetal-maternal unit reduces cardiac injury in late-preterm lambs subjected to severe prenatal asphyxia and cardiac arrest. Pediatr Res 2013; 73:427-34. [PMID: 23329199 DOI: 10.1038/pr.2013.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac dysfunction is reported to occur after severe perinatal asphyxia. We hypothesized that anesthesia of the mother with propofol during emergency cesarean section (c-section) would result in less cardiac injury (troponin T) in preterm fetuses exposed to global severe asphyxia in utero than anesthesia with isoflurane. We tested whether propofol decreases the activity of proapoptotic caspase-3 by activating the antiapoptotic AKT kinase family and the signal transducer and activator of transcription-3 (STAT-3). METHODS Pregnant ewes were randomized to receive either propofol or isoflurane anesthesia. A total of 44 late-preterm lambs were subjected to in utero umbilical cord occlusion (UCO), resulting in asphyxia and cardiac arrest, or sham treatment. After emergency c-section, each fetus was resuscitated, mechanically ventilated, and supported under anesthesia for 8 h using the same anesthetic as the one received by its mother. RESULTS At 8 h after UCO, the fetuses whose mothers had received propofol anesthesia had lower plasma troponin T levels, and showed a trend toward a higher median left ventricular ejection fraction (LVEF) of 84% as compared with 74% for those whose mothers had received isoflurane. Postasphyxia activation of caspase-3 was lower in association with propofol anesthesia than with isoflurane. Postasphyxia levels of STAT-3 and the AKT kinase family rose 655% and 500%, respectively with the use of propofol anesthesia for the mother. CONCLUSION The use of propofol for maternal anesthesia results in less cardiac injury in late-preterm lambs subjected to asphyxia than the use of isoflurane anesthesia. The underlying mechanism may be activation of the antiapoptotic STAT-3 and AKT pathways.
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Affiliation(s)
- Matthias Seehase
- Department of Paediatrics, Maastricht University Medical Center, School of Oncology, Maastricht, The Netherlands
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10
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Nam SW, Lee IH, Lee GH, Choi YO, Lee EH, Shin JH, Choi BM, Hong YS, Son CS. Myocardial Injury in Newborn Infants with Severe Metabolic Acidosis at the First Day of Life. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seong Woo Nam
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - In Hak Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Gui Hee Lee
- Department of Nursing, Korea University Ansan Hospital, Ansan, Korea
| | - Young Ok Choi
- Department of Nursing, Korea University Ansan Hospital, Ansan, Korea
| | - Eun Hee Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Jeong Hee Shin
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Byung Min Choi
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Young Sook Hong
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Chang Sung Son
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
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11
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Sadoh WE, Eregie CO. Cardiac troponin T as a marker of myocardial injury in a group of asphyxiated African neonates. Paediatr Int Child Health 2012; 32:43-6. [PMID: 22525447 DOI: 10.1179/1465328111y.0000000046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In caucasian newborns, troponin T (cTnT) is a specific marker for myocardial injury in perinatal asphyxia. This is the first such study in negroid neonates. AIMS To evaluate myocardial injury in a group of asphyxiated African newborns and determine the influence of mode of delivery on cTnT levels. METHODS Serum cTnT and clinical parameters in 40 asphyxiated and 40 healthy negroid neonatal controls were measured within the first 72 hours of life by chemiluminescence immune-assay. Perinatal asphyxia was assessed by APGAR score. The infants were followed up until discharge or death. RESULTS Mean (SD) cTnT values were significantly higher in asphyxiated infants [0.03 (0.04) ng/ml] than in healthy controls [0.01 (0.006) ng/ml, P = 0.002]. Asphyxiated infants delivered by forceps and vacuum extraction had significantly higher levels of cTnT [0.04 (0.018) ng/ml] than those born by caesarian section [0.02 (0.008) ng/ml] and by normal delivery [0.03 (0.01) ng/ml, P = 0.003]. cTnT levels were higher in infants who died (P = 0.037). CONCLUSION In the asphyxiated infants, mean cTnT levels were significantly higher than in controls. They were also significantly higher in those born by vacuum and forceps delivery and asphyxiated infants who died.
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Affiliation(s)
- W E Sadoh
- Department of Child Health,University of Benin, PMB 1154, Benin City, Nigeria.
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12
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[Cardiac troponin as biochemical marker of perinatal asphyxia and hypoxic myocardial injury]. VOJNOSANIT PREGL 2009; 66:881-6. [PMID: 20017418 DOI: 10.2298/vsp0911881s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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 microg/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 microg/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.
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Andresen JH, Carlsen B, Solberg R, Mørkrid L, Goverud IL, Løberg EM, Saugstad OD. Newborn piglets exposed to hypoxia after nicotine or saline pretreatment: Long-term effects on brain and heart. J Matern Fetal Neonatal Med 2009; 22:161-8. [DOI: 10.1080/14767050802663186] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Rajakumar PS, Vishnu Bhat B, Sridhar MG, Balachander J, Konar BC, Narayanan P, Chetan G. Electrocardiographic and echocardiographic changes in perinatal asphyxia. Indian J Pediatr 2009; 76:261-4. [PMID: 19082535 DOI: 10.1007/s12098-008-0221-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 11/11/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. METHODS Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. RESULTS Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. CONCLUSION C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.
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Affiliation(s)
- P S Rajakumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Rajakumar PS, Bhat BV, Sridhar MG, Balachander J, Konar BC, Narayanan P, Chetan G. Cardiac enzyme levels in myocardial dysfunction in newborns with perinatal asphyxia. Indian J Pediatr 2008; 75:1223-5. [PMID: 19190877 DOI: 10.1007/s12098-008-0242-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 11/11/2007] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. METHODS Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. RESULTS Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. CONCLUSION C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.
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Affiliation(s)
- P S Rajakumar
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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De Lucia V, Andreassi MG, Sabatini L, Ait-Ali L, Spadoni I, Giusti S. Myocardial infarction and arterial thrombosis in identical newborn twins with homozygosity for the PAI-1 4 G/5 G polymorphism. Int J Cardiol 2008; 137:e1-4. [PMID: 18703246 DOI: 10.1016/j.ijcard.2008.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 05/03/2008] [Indexed: 11/24/2022]
Abstract
Myocardial infarction in the perinatal period, in the absence of congenital heart disease or coronary artery lesions, is rare. The most common etiology described are the thromboembolism and perinatal asphyxia. We report a case of monozygotic twins who developed, after birth, acute vascular events and both had PAI-1 4G/4G homozygosity.
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Abstract
Cardiac troponins have a major role in screening and diagnosis of myocardial ischaemia in adults and children. Their introduction has redefined the diagnosis of myocardial infarction in adults and provided valuable prognostic information. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication, and can be used as predictors of subsequent cardiac recovery and mortality. This review discusses the current established reference values in term and preterm infants and demonstrates their potential use in neonatology. They may serve as a useful adjunct in the assessment of the magnitude of myocardial injury in respiratory distress syndrome and asphyxia. They may also benefit centres without on-site echocardiography with some evidence showing good correlation with echo-derived markers of myocardial function. The use of troponins in the neonatal unit remains a research tool. More work is needed to explore their prognostic role and monitoring response to treatment following cardioprotective strategies. In preterm infants the effect of inotropes on myocardial function needs further study and troponin may form an integral part of this research.
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Affiliation(s)
- Afif F El-Khuffash
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland.
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