Значај срчаног тропонина И друге генерације у раном испитивању хипоксичко-исхемијске енцефалопатије после перинаталне асфиксије

Abstract

Introduction In the last few years the use of cardiac troponin I and T, as diagnostic and prognostic factors of ischemic myocardial injury both in adult and neonatal medicine has been of great interest.

Objective The objective of our research was to investigate the significance of cardiac troponin I (cTnI) as an early indicator of the presence and severity of hypoxic-ischemic encephalopathy (HIE) in newborns.

Methods We analyzed 55 term newborns with HIE diagnosed based on clinical findings and ultrasonographic examination of the central nervous system. Serum concentration of cTnI-ultra was determined by immunoenzyme method during the first 24-48 hours after birth, and the obtained findings were compared with the values of identical parameter in 36 healthy term newborns.

Results During the first 24-48 hrs after birth, serum concentration of cTnI-ultra was significantly higher (p<0.0005) in term newborns with HIE (0.135±0.207 µg/l) and median (0.07, 0.01-006 µg/l) in comparison to control group (0.0183±0.026 µg/l and median 0.01 (0.01-0.01 µg/l), with the cTnI-ultra level rising proportionally to the clinical HIE stages. The increase of cTnI-ultra of >0.12 µg/l indicated the development of significant cerebral damage with the sensitivity of 75% and specificity of 72.2%, while the cTnI-ultra level of >0.13 µg/l was a significant mortality predictor with sensitivity of 76.9% and specificity of 73.8%.

Conclusion The second generation cardiac troponin I assay highly correlates with clinical and ultrasonographic findings in neonates with HIE, so that it can be used as a significant diagnostic and prognostic indicator of this pathological condition.

Keywords: hypoxic-ischemic encephalopathy; troponin I; newborn; prognosis