Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Jan 9, 2022; 11(1): 85-92
Published online Jan 9, 2022. doi: 10.5409/wjcp.v11.i1.85
Correlation of cardiac troponin T levels with inotrope requirement, hypoxic-ischemic encephalopathy, and survival in asphyxiated neonates
Ramesh Bhat Yellanthoor, Dineshkumar Rajamanickam
Ramesh Bhat Yellanthoor, Head of Unit 1, Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE) University, Manipal 576104, Karnataka, India
Dineshkumar Rajamanickam, Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE) University, Manipal 576104, Karnataka, India
Author contributions: Yellanthoor RB and Rajamanickam D conceptualized the study, analyzed and interpreted the data; Rajamanickam D collected the data; Yellanthoor RB wrote the manuscript and critically revised it; both Yellanthoor RB and Rajamanickam D approved the final manuscript.
Institutional review board statement: Ethical approval was obtained from the Institutional Ethical Committee.
Conflict-of-interest statement: Authors declare that there is no conflict of interest.
Data sharing statement: Authors agree to share the data at the reasonable request.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Bhat Yellanthoor, MBBS, MD, Doctor, Professor, Head of Unit 1, Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE) University, Udupi District, Manipal 576104, Karnataka, India. docrameshbhat@yahoo.co.in
Received: January 9, 2021
Peer-review started: January 9, 2021
First decision: May 6, 2021
Revised: June 20, 2021
Accepted: December 7, 2021
Article in press: December 7, 2021
Published online: January 9, 2022
Abstract
BACKGROUND

Cardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality.

AIM

To assess cardiac troponin T (cTnT) levels in asphyxiated neonates and their correlation with echocardiography findings, inotrope requirement, hypoxic-ischemic encephalopathy (HIE) stages, and mortality.

METHODS

cTnT levels, echocardiographic findings, the requirement of inotropes, HIE stages, and outcome were studied in neonates of gestational age ≥ 34 wk with perinatal asphyxia.

RESULTS

Among 57 neonates with perinatal asphyxia, male gender, cesarean section, forceps/vacuum-assisted vaginal delivery and late preterm included 33 (57.9%), 23 (40.4%), 3 (5.3%), and 12 (21.1%) respectively. The mean gestational age was 38.4 wk (1.6 wk). HIE stages I, II, and III were observed in 7 (12.3%), 37 (64.9%), and 9 (15.8%) neonates respectively. 26 (45.6%) neonates had echocardiographic changes and 19 (33.3%) required inotropes. cTnT levels were elevated in 41 (71.9%) neonates [median (IQR); 0.285 (0.211-0.422) ng/mL]. The Median cTnT level showed an increasing trend with increasing changes in echocardiography (P = 0.002). Two neonates with mitral regurgitation and global hypokinesia had the highest cTnT levels (1.99 and 0.651 ng/mL). Of 31 neonates with normal echocardiography, 18 (58.06%) showed elevated cTnT. cTnT levels were significantly higher in those who required inotropic support than those who did not (P = 0.007). Neonates with HIE stage III had significantly higher cTnT levels compared to those with HIE stage I/II (P = 0.013). Survivors had lower median cTnT levels [0.210 (0.122-0.316) ng/mL] than who succumbed [0.597 (0.356-1.146) ng/mL].

CONCLUSION

cTnT levels suggestive of cardiac involvement were observed in 71.9% of asphyxiated neonates. cTnT levels correlated with echocardiography findings, inotrope requirement, HIE stages, and mortality.

Keywords: Asphyxia, Cardiac dysfunction, Inotropes, Neonates, troponin T, Survival

Core Tip: Cardiac involvement in perinatal asphyxia complicates the management and increases mortality. We assessed cardiac troponin T (cTnT) levels in asphyxiated neonates and their correlation with echocardiography findings, hypoxic-ischemic encephalopathy (HIE) stages, and mortality. Elevated cTnT levels suggestive of cardiac involvement were found in 71.9% of neonates and correlated with increasing grades of ischemic changes in echocardiography. cTnT levels were elevated in 58% of neonates in the absence of echocardiographic findings. Significantly higher cTnT levels in neonates with HIE stage III than those with HIE stage I and II as well as higher cTnT levels in non-survivors than survivors show its predictive role.