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Nwankwo O, Adiele DK, Ekwochi U, Idoko CA, Obidike EK. Evaluation of Myocardial Injury Using Serum Cardiac Troponin-I in Asphyxiated Neonates at Enugu State University Teaching Hospital, Enugu, South-East Nigeria. Niger J Clin Pract 2024; 27:792-799. [PMID: 38943306 DOI: 10.4103/njcp.njcp_169_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs. STUDY AIM To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI). METHODS The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia. RESULTS The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001). CONCLUSION serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.
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Affiliation(s)
- O Nwankwo
- Department of Paediatrics, College of Medicine, Enugu State University Teaching Hospital (ESUTH), Park Lane, Enugu, Enugu State, Nigeria
| | - D K Adiele
- Department of Paediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu State, Nigeria
| | - U Ekwochi
- Department of Paediatrics, College of Medicine, Enugu State University Teaching Hospital (ESUTH), Park Lane, Enugu, Enugu State, Nigeria
| | - C A Idoko
- Department of Community Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu State, Nigeria
| | - E K Obidike
- Department of Paediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu State, Nigeria
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Jano E, Vaz MJ, Mally PN, Wachtel EV. Pilot Study Investigating Brain Natriuretic Peptide, Troponin, Galectin-3, and miRNA-126a-5p as Biomarkers of Persistent Pulmonary Hypertension in Neonates with Hypoxic-Ischemic Injury Receiving Therapeutic Hypothermia. Am J Perinatol 2024; 41:e60-e68. [PMID: 35436801 DOI: 10.1055/a-1827-7518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective was to evaluate the utility of brain natriuretic peptide (BNP), troponin, galectin-3 (Gal-3), and microRNA (miRNA)-126a-5p as screening biomarkers for persistent pulmonary hypertension of the newborn (PPHN) by comparing expression in serum of infants with hypoxic-ischemic injury that develop PPHN to those that do not. STUDY DESIGN This was a prospective, observational pilot study including neonates with hypoxic-ischemic injury undergoing therapeutic hypothermia (TH) at two regional perinatal medical centers. PPHN in this population was diagnosed clinically and confirmed by echocardiogram. Serial measurements of biomarkers were performed from 6 to 96 hours post-TH initiation in 40 patients. RESULTS Of 40 infants in the study, 10 (25%) developed PPHN and 30 (75%) did not. Baseline demographics and hemodynamics were similar between the groups. Patients with PPHN had a significantly higher need for vasopressors compared with patients without PPHN (70 vs. 27%, p = 0.007). Mean serum BNP and troponin levels were significantly higher in the PPHN group peaking at 12 to 24 hours and decreasing following PPHN treatment initiation. miRNA-126a-5p expression was increased in patients with PPHN compared with patients without, with statistical significance detected at 12 hours (p = 0.005) and 96 hours (p = 0.01). Mean circulating Gal-3 levels were not statistically different between the two groups; however, Gal-3 was elevated in all patients with hypoxic-ischemic injury on TH compared with healthy infants from prior studies. CONCLUSION BNP and troponin are readily available, low-cost biomarkers that showed significant serial elevations in the PPHN group of the study and, thus, may have value in screening for PPHN in the setting of hypoxic-ischemic encephalopathy (HIE). Gal-3 was elevated in all patients with HIE and may be a useful biomarker of hypoxic injury in infants being evaluated for TH. Elevations in miRNA-126a-5p were not consistently seen in this study. Larger studies are required to establish an association between PPHN and these biomarkers in patients with and without HIE. KEY POINTS · Serum biomarkers of persistent pulmonary hypertension of the newborn. · Serum biomarkers of hypoxic-ischemic injury.
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Affiliation(s)
- Eni Jano
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Michelle J Vaz
- Department of Pediatrics, NYU Grossman School of Medicine, Bellevue Hospital Center Neonatal Intensive Care Unit, New York, New York
| | - Pradeep N Mally
- Department of Pediatrics, NYU Grossman School of Medicine, Bellevue Hospital Center Neonatal Intensive Care Unit, New York, New York
| | - Elena V Wachtel
- Department of Pediatrics, NYU Grossman School of Medicine, Bellevue Hospital Center Neonatal Intensive Care Unit, New York, New York
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Geisinger R, Rios DR, McNamara PJ, Levy PT. Asphyxia, Therapeutic Hypothermia, and Pulmonary Hypertension. Clin Perinatol 2024; 51:127-149. [PMID: 38325938 DOI: 10.1016/j.clp.2023.11.007] [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] [Indexed: 02/09/2024]
Abstract
Neonates with a perinatal hypoxic insult and subsequent neonatal encephalopathy are at risk of acute pulmonary hypertension (aPH) in the transitional period. The phenotypic contributors to aPH following perinatal asphyxia include a combination of hypoxic vasoconstriction of the pulmonary vascular bed, right heart dysfunction, and left heart dysfunction. Therapeutic hypothermia is the standard of care for neonates with moderate-to-severe hypoxic ischemic encephalopathy. This review summarizes the underlying risk factors, causes of aPH in neonates with perinatal asphyxia, discusses the unique phenotypical contributors to disease, and explores the impact of the initial insult and subsequent therapeutic hypothermia on aPH.
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Affiliation(s)
- Regan Geisinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Danielle R Rios
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 436, Boston, MA 02115, USA.
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Gözde Kanmaz Kutman H, Kadıoğlu Şimşek G, Ceran B, Beşer E, Emre Canpolat F. Troponin I, CK-MB, and inotropic score in hypoxic-ischemic encephalopathy and associated infant mortality. BMC Pediatr 2023; 23:511. [PMID: 37845609 PMCID: PMC10578001 DOI: 10.1186/s12887-023-04311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE Cardiovascular dysfunction is common in hypoxic-ischemic encephalopathy (HIE), which is one of the leading causes of multi-organ failure in neonates. We aimed to assess troponin I and creatine kinase myocardial band (CK-MB) levels, inotropic score (IS) in HIE patients, and their associations with HIE staging and mortality. METHOD The medical records of all HIE infants admitted to our unit between 2016 and 2018 were retrospectively analyzed. Demographic characteristics of the infants, seizures, anticonvulsive therapies, maximum inotrope doses, and the derived IS (dopamine dose [µg/kg/min] + dobutamine dose [µg/kg/min] + 100 × epinephrine dose [µg/kg/min]) and CK-MB and troponin-I levels obtained in the first six hours of life were compared according to HIE staging. Comparisons between survivors and non-survivors were made. RESULTS The study included data from 195 patients. Twenty-five patients were classified as stage 3, 116 as stage 2, and 54 as stage 1 HIE. Median Troponin-I, CK-MB level, and IS significantly differed by HIE staging (p < 0.01). The deceased infants had significantly higher median troponin I level [0.36 (0.02-3) vs. 0.16 (0.01-1.1) ng/ml; p = 0.006], median IS [20 (5-120) vs. 5 (5-10); p < 0.001], however, CK-MB values were comparable with survivors [129 (51-300) vs. 60.7 (31-300) ng/ml; p = 0.57]. The area under the curve was 0.93 for IS and 0.81 for Troponin I to predict mortality. CONCLUSION Troponin I, CK-MB, and IS could be successfully used as disease severity markers in HIE furthermore, troponin I and IS, are good predictors of mortality. These results need to be confirmed with larger prospective multi-center studies.
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Affiliation(s)
- Hayriye Gözde Kanmaz Kutman
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey.
| | - Gülsüm Kadıoğlu Şimşek
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
| | - Burak Ceran
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
| | - Esra Beşer
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
| | - Fuat Emre Canpolat
- Department of Neonatology, University of Health Sciences, Ankara City Hospital MH5, 06800, Çankaya, Ankara, Turkey
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Munshi UK, Brown MM, Tauber KA, Horgan MJ. Early Troponin I Levels in Newborns Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Residual Encephalopathy at Discharge. Am J Perinatol 2022; 39:1083-1088. [PMID: 33285603 DOI: 10.1055/s-0040-1721497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Elevation of serum troponin I has been reported in newborns with hypoxic ischemic encephalopathy (HIE), but it is diagnostic and prognostic utility for newborn under 6 hours is not clear. Study the predictive value of early serum troponin I levels in newborns with HIE undergoing therapeutic hypothermia (TH) for persistent residual encephalopathy (RE) at discharge. STUDY DESIGN Retrospective chart review of newborns admitted with diagnosis of HIE to neonatal intensive care unit (NICU) for TH over a period of 3 years. Troponin levels were drawn with the initial set of admission laboratories while initiating TH. Newborns were followed up during hospital course and stratified into three groups based on predischarge examination and their electrical encephalography and cranial MRI findings: Group 1: no RE, Group 2: mild-to-moderate RE, and Group 3: severe RE or needing assisted medical technology or death. Demographic and clinical characteristics including troponin I levels were compared in each group. RESULTS Out of 104 newborns who underwent TH, 65 infants were in Group 1, 26 infants in Group 2, and 13 newborns in Group 3. All groups were comparable in demographic characteristics. There was a significant elevation of serum troponin in group 2 (mild-to-moderate RE) and group 3 (severe RE) as compared with group 1 (no RE). Receiver operator curve analysis for any RE (groups 2 and 3) compared with group 1 (no RE as control) had 0.88 (0.81-0.95) area under curve, p < 0.001. A cut-off level of troponin I ≥0.12 µg/L had a sensitivity of 77% and specificity of 78% for diagnosis of any RE, positive predictive value of 68%, and a negative predictive value of 84%. CONCLUSION In newborns undergoing TH for HIE, the elevation of troponin within 6 hours of age predicts high risk of having RE at discharge. KEY POINTS · Troponin I elevation is a biomarker of myocardial ischemia in adults and children.. · Myocardial ischemia may be part of multi-organ injury in neonatal HIE.. · Early elevation of troponin I level may correlate with the severity of neonatal HIE and predict residual encephalopathy in newborn at discharge from initial hospitalization..
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Affiliation(s)
- Upender K Munshi
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Meredith Monaco Brown
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Kate A Tauber
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Michael J Horgan
- Division of Neonatology, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
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Bor M, Ilhan O, Karaca M, Calik M. Risk Factors for Clinical Seizures in Neonates with Hypoxic-ischemic Encephalopathy Treated with Therapeutic Hypothermia. KLINISCHE PADIATRIE 2022; 234:206-214. [PMID: 35231937 DOI: 10.1055/a-1731-7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study aimed to assess the risk factors for clinical seizures in newborns treated with whole body cooling (WBC) for hypoxic ischemic encephalopathy (HIE). METHODS Infants with gestational age≥36 weeks and birth weight≥2.000 g who were treated with WBC due to HIE were retrospectively enrolled in this study. Patients were assigned to two groups: infants without clinical seizures (Group 1) and infants with clinical seizures (Group 2). The two groups were compared to determine the risk factors for the occurrence of clinical seizures. RESULTS A total of 25 patients (Group 1=10 and Group 2=15) were included in the study. Prothrombin time (PT) was determined as independent risk factor for clinical seizures (p=0.046) and the odds ratio for the effect of PT was found as 1.475 (%95 CI:1.006-2.299). PT (area under the curve [AUC]=0.764; p=0.041), and increased cardiac troponin-I (cTnI) (AUC=0.935; p=0.002) were found to be significant risk factors for predicting the occurrence of clinical seizures. The optimal PT cut-off value was 22.7 sec, with a sensitivity and specificity of 45.4% and 90%, respectively; as well as positive and negative predictive value of 83.3% and 60.0%, respectively. The chest compression in the delivery room, severely abnormal amplitude integrated electroencephalography and high encephalopathy score were also found risk factors for occurrence of clinical seizures. CONCLUSION Chest compression in the delivery room, high encephalopathy score, prolonged PT, and increased cTnI are significant factors for clinical seizures in newborns treated with WBC for HIE.
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Affiliation(s)
- Meltem Bor
- Department of Pediatrics, Division of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Ozkan Ilhan
- Department of Pediatrics, Division of Neonatology, Harran University School of Medicine, Sanliurfa, Turkey.,Department of Pediatrics, Division of Neonatology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Meryem Karaca
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Harran University School of Medicine, Sanliurfa, Turkey
| | - Mustafa Calik
- Department of Pediatrics, Division of Pediatric Neurology, Harran University School of Medicine, Sanliurfa, Turkey
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Alexander PMA, Checchia PA, Ryerson LM, Bohn D, Eckerle M, Gaies M, Laussen P, Jeffries H, Thiagarajan RR, Shekerdemian L, Bembea MM, Zimmerman JJ, Kissoon N. Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference. Pediatrics 2022; 149:S39-S47. [PMID: 34970677 PMCID: PMC9745438 DOI: 10.1542/peds.2021-052888f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Cardiovascular dysfunction is associated with poor outcomes in critically ill children. OBJECTIVE We aim to derive an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 using medical subject heading terms and text words to define concepts of cardiovascular dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION Studies were included if they evaluated critically ill children with cardiovascular dysfunction and assessment and/or scoring tools to screen for cardiovascular dysfunction and assessed mortality, functional status, organ-specific, or other patient-centered outcomes. Studies of adults, premature infants (≤36 weeks gestational age), animals, reviews and/or commentaries, case series (sample size ≤10), and non-English-language studies were excluded. Studies of children with cyanotic congenital heart disease or cardiovascular dysfunction after cardiopulmonary bypass were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form, along with risk-of-bias assessment by a task force member. RESULTS Cardiovascular dysfunction was defined by 9 elements, including 4 which indicate severe cardiovascular dysfunction. Cardiopulmonary arrest (>5 minutes) or mechanical circulatory support independently define severe cardiovascular dysfunction, whereas tachycardia, hypotension, vasoactive-inotropic score, lactate, troponin I, central venous oxygen saturation, and echocardiographic estimation of left ventricular ejection fraction were included in any combination. There was expert agreement (>80%) on the definition. LIMITATIONS All included studies were observational and many were retrospective. CONCLUSIONS The Pediatric Organ Dysfunction Information Update Mandate panel propose this evidence-informed definition of cardiovascular dysfunction.
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Affiliation(s)
- Peta MA Alexander
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston MA USA
| | - Paul A Checchia
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston TX USA
| | - Lindsay M Ryerson
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - Desmond Bohn
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati OH USA and Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati OH USA
| | - Michael Gaies
- Department of Pediatrics, University of Michigan, Ann Arbor, MI USA
| | - Peter Laussen
- Department of Cardiology, Boston Children’s Hospital and Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Howard Jeffries
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA USA
| | - Ravi R. Thiagarajan
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston MA USA
| | - Lara Shekerdemian
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston TX USA
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital/Harborview Medical Center, University of Washington School of Medicine
| | - Niranjan Kissoon
- Division of Critical Care, Department of Pediatrics, University of British Columbia and BC Children’s Hospital
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Tu YF, Wu PM, Yu WH, Li CI, Wu CL, Kang L, Lin YC, Shih HI, Huang CC. Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study. Life (Basel) 2021; 11:life11111193. [PMID: 34833069 PMCID: PMC8618528 DOI: 10.3390/life11111193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is the most common cause of mortality and neurological disability in infancy after perinatal asphyxia. Reliable biomarkers to predict neurological outcomes of neonates after perinatal asphyxia are still not accessible in clinical practice. Methods: A prospective cohort study enrolled neonates with perinatal asphyxia. Biochemical blood tests and cerebral Doppler ultrasound were measured within 6 h of age and at the 4th day old. Neurological outcomes were assessed at 1 year old. Results: Sixty-four neonates with perinatal asphyxia were enrolled. Fifty-eight (90%) had hypoxic-ischemic encephalopathy (HIE) including 20 (34%) Stage I, 21 (36%) Stage II, and 17 (29%) Stage III. In the asphyxiated infants without therapeutic hypothermia, HIE stage, PH, and base excess levels within 6 h of age were the predictors of adverse outcomes. In the asphyxiated infants receiving therapeutic hypothermia, HIE stage failed to predict outcomes. Instead, blood lactate levels and pulsatility index (PI) of medial cerebral arteries (MCA) either in 6 h of age or at the 4th day old independently predicted adverse outcomes. Conclusions: Blood lactate, which is a common accessible test at the hospital and MCA PI on cerebral ultrasound could predict adverse outcomes in asphyxiated infants receiving therapeutic hypothermia.
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Affiliation(s)
- Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan; (P.-M.W.); (W.-H.Y.); (Y.-C.L.)
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan;
- Correspondence: (Y.-F.T.); (C.-C.H.); Tel.: +886-6-235-3535 (ext. 5273) (Y.-F.T.)
| | - Po-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan; (P.-M.W.); (W.-H.Y.); (Y.-C.L.)
| | - Wen-Hao Yu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan; (P.-M.W.); (W.-H.Y.); (Y.-C.L.)
| | - Chung-I Li
- Department of Statistics, College of Management, National Cheng Kung University, Tainan City 70101, Taiwan;
| | - Cheng-Lin Wu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan;
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan
| | - Lin Kang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan;
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan; (P.-M.W.); (W.-H.Y.); (Y.-C.L.)
| | - Hsin-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan;
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70403, Taiwan; (P.-M.W.); (W.-H.Y.); (Y.-C.L.)
- Correspondence: (Y.-F.T.); (C.-C.H.); Tel.: +886-6-235-3535 (ext. 5273) (Y.-F.T.)
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Abstract
Neonatal encephalopathy due to perinatal hypoxia-ischemia (hypoxic-ischemic encephalopathy [HIE]) occurs at a rate of 1 to 3 per 1000 live births. Therapeutic hypothermia is the standard of care and the only currently available therapy to reduce the risk of death or disability in newborns with moderate to severe HIE. Hypothermia therapy needs to be initiated within 6 hours after birth in order to provide the best chance for neuroprotection. All pediatricians and delivery room attendants should be trained to recognize encephalopathy and understand the eligibility criteria for treatment. The modified Sarnat examination is the most frequently used tool to assess the degree of encephalopathy and has six categories, each of which can have mild, moderate, severe abnormalities. Apart from historical and biochemical criteria, a neonate must have 3 of 6 categories scored in the moderate or severe range in order to qualify for hypothermia as was done in the randomized trials. Whether an infant qualifies or there is concern that an infant might have HIE, transfer to a center that can perform treatment should be initiated immediately. Hypothermia significantly reduces the risk of death or moderate to severe impairments at 2 years and at school age. On average, only 7 neonates need to be treated for one neonate to benefit. Although easy in concept, implementation of hypothermia does require expertise and should be carried out under the guidance of a neonatologist. If infants are passively cooled prior to transport, core temperature needs to be closely monitored with a target of 33.5°C ± 0.5°C. Maintenance of homeostasis is important in order to prevent conditions that may result in additional brain injury. Seizures are common in neonates with HIE, but electrographic seizures are rare in the first few hours after birth if the insult occurred during labor and delivery. Prophylactic antiepileptic drugs should not be administered. Brain monitoring in the form of electroencephalogram (EEG) and or amplitude-integrated EEG should be implemented as soon as possible to help with prognosis and to accurately diagnose seizures.
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Affiliation(s)
- Sonia Lomeli Bonifacio
- NeuroNICU, Division of Neonatal and Developmental Medicine, 750 Welch Road, Suite 315, Palo Alto, CA, USA.
| | - Shandee Hutson
- Department of Neonatology, NICN, Sharp Mary Birch Hospital for Women and Newborns, 8555 Aero Drive #104, San Diego, CA 92123, USA
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10
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Rios DR, Lapointe A, Schmolzer GM, Mohammad K, VanMeurs KP, Keller RL, Sehgal A, Lakshminrusimha S, Giesinger RE. Hemodynamic optimization for neonates with neonatal encephalopathy caused by a hypoxic ischemic event: Physiological and therapeutic considerations. Semin Fetal Neonatal Med 2021; 26:101277. [PMID: 34481738 DOI: 10.1016/j.siny.2021.101277] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Neonatal encephalopathy due to a hypoxic-ischemic event is commonly associated with cardiac dysfunction and acute pulmonary hypertension; both therapeutic hypothermia and rewarming modify loading conditions and blood flow. The pathophysiological contributors to disease are complex with a high degree of clinical overlap and traditional bedside measures used to assess circulatory adequacy have multiple confounders. Comprehensive, quantitative echocardiography may be used to delineate the relative contribution of lung parenchymal, pulmonary vascular, and cardiac disease to hypotension and/or hypoxemic respiratory failure. In this review, we provide a detailed overview of the contributors to hemodynamic instability following perinatal hypoxic-ischemic injury. Our proposed approach to therapy focuses on physiopathological considerations with interventions individualized to this potentially complex condition and considers the pharmacological idiosyncrasies, which may occur among neonates with NE presenting with multiorgan dysfunction while undergoing therapeutic hypothermia.
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Affiliation(s)
- Danielle R Rios
- Department of Pediatrics, Division of Neonatology, University of Iowa, MS 200 Hawkins Drive 8800 JPP, Iowa City, IA, 52242, USA.
| | - Anie Lapointe
- CHU Ste-Justine, Montreal University, CHU Sainte-Justine 3175, chemin Côte Sainte-Catherine Montréal (Québec), H3T 1C5, Canada.
| | - Georg M Schmolzer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, 10240 Kingsway Avenue NW AB, Edmonton, T5H 3V9, Canada.
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Neonatology, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
| | - Krisa P VanMeurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Center for Academic Medicine Division of Neonatology - MC 5660 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Roberta L Keller
- Department of Pediatrics, University of California San Francisco, 550 16th. Street, San Francisco, CA, 94158, USA.
| | - Arvind Sehgal
- Department of Pediatrics, Monash University, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
| | - Satyan Lakshminrusimha
- Department of Pediatrics, Division of Neonatology, University of California, Davis, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Regan E Giesinger
- Department of Pediatrics, Division of Neonatology, University of Iowa, MS 200 Hawkins Drive 8800 JPP, Iowa City, IA, 52242, USA.
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11
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Thermal Index for early non-invasive assessment of brain injury in newborns treated with therapeutic hypothermia: preliminary report. Sci Rep 2021; 11:12578. [PMID: 34131269 PMCID: PMC8206354 DOI: 10.1038/s41598-021-92139-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.
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12
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Sweetman DU, Kelly L, Hurley T, Onwuneme C, Watson RWG, Murphy JFA, Slevin M, Donoghue V, Molloy EJ. Troponin T correlates with MRI results in neonatal encephalopathy. Acta Paediatr 2020; 109:2266-2270. [PMID: 32281692 DOI: 10.1111/apa.15255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/09/2020] [Accepted: 03/12/2020] [Indexed: 01/08/2023]
Abstract
AIM Troponin is a sensitive marker of asphyxia in term infants mirroring the myocardial injury sustained in global hypoxia-ischaemia. In addition, troponin is a sensitive marker of severity of stroke in adults and neonatal encephalopathy (NE). We aimed to examine the relationship between troponin T in infants with perinatal asphyxia and brain injury on MRI and correlate with neurodevelopmental outcome. METHODS Serum troponin was sampled in infants requiring resuscitation at birth and/or neonatal encephalopathy in a tertiary referral neonatal centre. Birth history, clinical parameters, neuroimaging and developmental outcome (Bayley Scores of Infant Development [BSID] III) were evaluated. RESULTS Infants with perinatal asphyxia (n = 54) had serum troponin T measured and 27 required therapeutic hypothermia. Troponin T levels on days 1 and 2 were predictive of need for TH, development of seizures and grade II/III NE (AUC = 0.7; P-values < .001), troponin T levels on days 1, 2 and 3 were highly significant predictors of mortality (AUC = 0.99, P-values .005). The cut-off values of troponin T for best prediction of mortality were 0.84, 0.63 and 0.58 ng/mL on days 1, 2 and 3, respectively. Troponin T on day 3 of life was predictive of injury in the combined area of basal ganglia/watershed on MRI (AUC 0.70; P-value = .045). CONCLUSION Infants with brain injury on neuroimaging following perinatal asphyxia had significantly elevated serum troponin, and troponin also correlated with developmental scores at 2 years. Further studies combining troponin and MRI may assist in the classification of neonatal brain injury to define aetiology, prognosis and response to treatment.
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Affiliation(s)
- Deirdre U. Sweetman
- Department of Neonatology National Maternity Hospital Dublin Ireland
- National Children’s Research Centre Dublin Ireland
- Department of Paediatrics Royal College of Surgeons in Ireland Dublin Ireland
| | - Lynne Kelly
- Department of Paediatrics Trinity College Dublin Children’s Health Ireland in Tallaght & Trinity Translational Medicine Institute St James Hospital Dublin Ireland
| | - Tim Hurley
- Department of Paediatrics Trinity College Dublin Children’s Health Ireland in Tallaght & Trinity Translational Medicine Institute St James Hospital Dublin Ireland
- Coombe Women’s and infant’s University Hospital Dublin Ireland
| | - Chike Onwuneme
- Department of Neonatology National Maternity Hospital Dublin Ireland
- UCD School of Medicine and Medical Sciences University College Dublin Dublin Ireland
| | | | - John F. A. Murphy
- Department of Neonatology National Maternity Hospital Dublin Ireland
- UCD School of Medicine and Medical Sciences University College Dublin Dublin Ireland
| | - Marie Slevin
- Department of Neonatology National Maternity Hospital Dublin Ireland
| | - Veronica Donoghue
- Department of Neonatology National Maternity Hospital Dublin Ireland
| | - Eleanor J. Molloy
- Department of Neonatology National Maternity Hospital Dublin Ireland
- National Children’s Research Centre Dublin Ireland
- Department of Paediatrics Royal College of Surgeons in Ireland Dublin Ireland
- Department of Paediatrics Trinity College Dublin Children’s Health Ireland in Tallaght & Trinity Translational Medicine Institute St James Hospital Dublin Ireland
- Coombe Women’s and infant’s University Hospital Dublin Ireland
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13
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Giesinger RE, El Shahed AI, Castaldo MP, Breatnach CR, Chau V, Whyte HE, El-Khuffash AF, Mertens L, McNamara PJ. Impaired Right Ventricular Performance Is Associated with Adverse Outcome after Hypoxic Ischemic Encephalopathy. Am J Respir Crit Care Med 2020; 200:1294-1305. [PMID: 31251076 DOI: 10.1164/rccm.201903-0583oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Asphyxiated neonates with hypoxic ischemic encephalopathy (HIE) are at risk of myocardial dysfunction; however, echocardiography studies are limited and little is known about the relationship between hemodynamics and brain injury.Objectives: To analyze the association between severity of myocardial dysfunction and adverse outcome as defined by the composite of death and/or abnormal magnetic resonance imaging.Methods: Neonates with HIE undergoing therapeutic hypothermia were enrolled. Participants underwent echocardiography at 24 hours, 72 hours (before rewarming), and 96 hours (after rewarming). Cerebral hemodynamics were monitored by near-infrared spectroscopy and middle cerebral artery Doppler.Measurements and Main Results: Fifty-three patients with a mean gestation and birthweight of 38.8 ± 2.0 weeks and 3.33 ± 0.6 kg, respectively, were recruited. Thirteen patients (25%) had mild encephalopathy, 27 (50%) had moderate encephalopathy, and 13 (25%) had severe encephalopathy. Eighteen patients (34%) had an adverse outcome. Severity of cardiovascular illness (P < 0.001) and severity of neurologic insult (P = 0.02) were higher in neonates with adverse outcome. Right ventricle (RV) systolic performance at 24 hours was substantially lower than published normative data in all groups. At 24 hours, lower tricuspid annular plane systolic excursion (P = 0.004) and RV fractional area change (P < 0.001), but not pulmonary hypertension, were independently associated with adverse outcome on logistic regression. High brain regional oxygen saturation (P = 0.007) and low middle cerebral artery resistive index (P = 0.04) were associated with RV dysfunction on post hoc analysis.Conclusions: RV dysfunction is associated with the risk of adverse outcome in asphyxiated patients with HIE undergoing hypothermia. Echocardiography may be a valuable diagnostic and prognostic tool in this vulnerable population.
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Affiliation(s)
| | | | | | - Colm R Breatnach
- Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; and
| | | | - Hilary E Whyte
- Division of Neonatology and.,Department of Paediatrics and
| | - Afif F El-Khuffash
- Department of Paediatrics, The Rotunda Hospital, Dublin, Ireland; and.,Department of Paediatrics, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luc Mertens
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick J McNamara
- Division of Neonatology and.,Department of Paediatrics and.,Department of Physiology, The University of Toronto, Toronto, Ontario, Canada
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14
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Bhasin H, Kohli C. Myocardial dysfunction as a predictor of the severity and mortality of hypoxic ischaemic encephalopathy in severe perinatal asphyxia: a case-control study. Paediatr Int Child Health 2019; 39:259-264. [PMID: 30810512 DOI: 10.1080/20469047.2019.1581462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: In perinatal asphyxia, hypoxia often leads to myocardial ischaemia. Few studies have assessed the degree of myocardial dysfunction in severely asphyxiated term neonates. Aim: To assess the extent of myocardial damage in newborns with severe perinatal asphyxia. Methods: A case-control study was conducted in asphyxiated newborns with hypoxic ischaemic encephalopathy (HIE) and in controls who were term non-asphyxiated newborns. Total (T) creatinine kinase (CK), CK-MB, troponin-T and 12-lead electrocardiography (ECG) and echocardiography were performed in both groups within 24-48 h after birth. The proportions of asphyxiated neonates with myocardial dysfunction and its relationship between severity of HIE and immediate outcome was compared. Results: Five of 23 asphyxiated neonates developed stage I, 10 stage II and eight stage III HIE. Serum levels of CK-T and CK-MB were raised in all 23 cases and troponin-T was raised in 13 (56.5%) HIE cases. ECG was abnormal in all cases and echocardiography in three (13%). Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were significantly decreased in all asphyxiated neonates. Eight (35%) patients died. Enzyme levels were higher and ECG and echocardiography abnormalities were common in infants with more severe HIE (p <0.05). Mean serum levels of CK-T and MB (p <0.001) and troponin-T (p =0.002) were higher in non-survivors. Mean LVEF and RVEF values were higher in survivors (p <0.001). All the controls had normal enzyme levels and echocardiography. ECG was abnormal in one control. Conclusion: Cardiac enzymes, ECG and echocardiography changes were associated with increasing severity of HIE and mortality.
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Affiliation(s)
- Himani Bhasin
- Department of Pediatrics, Shree Guru Gobind Singh Tricentenary Medical College , Delhi , India
| | - Charu Kohli
- Department of Community Medicine, Geetanjali Medical College and Hospital , Udaipur , India
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15
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Jiang L, Li Y, Zhang Z, Lin L, Liu X. Use of high-sensitivity cardiac troponin I levels for early diagnosis of myocardial injury after neonatal asphyxia. J Int Med Res 2019; 47:3234-3242. [PMID: 31189368 PMCID: PMC6683911 DOI: 10.1177/0300060519831187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Low-cost diagnostic and prognostic biomarkers could help guide clinical management of neonates with myocardial injury after asphyxia. This study aimed to assess the utility of creatine kinase (CK)-MB, high-sensitivity cardiac troponin I (hs-cTnI), brain natriuretic peptide (BNP), and myoglobin in the early diagnosis of myocardial injury following neonatal asphyxia. Methods Eighteen neonates with asphyxia and myocardial injury, 22 neonates with asphyxia and no myocardial injury, and 19 neonates without asphyxia (controls) were enrolled consecutively at the Neonatology Department, First Hospital of Lanzhou University (August 2013 to December 2014). Serum CK-MB, hs-cTnI, BNP, and myoglobin levels were evaluated at 12 hours and 7 days after birth. Their diagnostic value for myocardial injury was assessed by receiver operating characteristic (ROC) curve analysis. Results Levels of all four markers were higher in neonates with asphyxia and myocardial injury than in neonates with asphyxia and no myocardial injury or controls 12 hours after birth. The marker hs-cTnI had the highest diagnostic value. Using a cutoff value of 0.087 µg/L for hs-cTnI, the sensitivity, specificity, and diagnostic accuracy for asphyxia-induced myocardial injury were 55.6%, 95.5%, and 77.5%, respectively. Conclusions Serum hs-cTnI levels can predict myocardial injury caused by neonatal asphyxia at an early stage.
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Affiliation(s)
- Li Jiang
- 1 Pediatrics, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuning Li
- 1 Pediatrics, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Zhi Zhang
- 2 Physical Examination Center, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Lixing Lin
- 1 Pediatrics, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoli Liu
- 3 Pediatrics, Maternal and Child Care Service Center, Liuzhou, Guangxi Province, China
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16
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Caredda E, Rosso R, Capristo C, Montaldo P. False-positive troponin I elevation in a newborn with neonatal encephalopathy. BMJ Case Rep 2019; 12:12/5/e229217. [PMID: 31122959 DOI: 10.1136/bcr-2019-229217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Serum biomarkers of myocardial damage are commonly used in babies after perinatal asphyxia. We present a case report of a persistently troponin I elevation without evidence of clinical or instrumental signs of myocardial ischaemia in a baby with perinatal asphyxia. When the blood was mixed with polyethylene glycol we found that the troponin I levels were falsely elevated due to interfering antibodies. This case shows that analytical errors may still occur despite modern immunoassay systems and underlines the need for further investigations to identify false-positive values in case of disagreement between clinical conditions and laboratory values.
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Affiliation(s)
- Elisabetta Caredda
- Department of Neonatal Intensive Care, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Rosso
- Neonatal Intensive Care, Monaldi Hospital, Naples, Italy
| | - Carlo Capristo
- Department of Neonatal Intensive Care, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Montaldo
- Department of Neonatal Intensive Care, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Paediatrics, Centre for Perinatal Neuroscience, Imperial College London, London, UK
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17
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Natarajan G, Laptook A, Shankaran S. Therapeutic Hypothermia: How Can We Optimize This Therapy to Further Improve Outcomes? Clin Perinatol 2018; 45:241-255. [PMID: 29747886 PMCID: PMC5953210 DOI: 10.1016/j.clp.2018.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neonatal hypoxic-ischemic encephalopathy remains associated with considerable death and disability. In multiple randomized controlled trials, therapeutic hypothermia for neonatal moderate or severe hypoxic-ischemic encephalopathy among term infants has been shown to be safe and effective in reducing death and disability in survivors. In this article, the current status of infant and childhood outcomes following this therapy is reviewed. The clinical approaches that may help to optimize this innovative neuroprotective therapy are presented.
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Affiliation(s)
- Girija Natarajan
- Department of Pediatrics, Wayne State University, Children’s Hospital of Michigan and Hutzel Women’s Hospital, Detroit, MI
| | - Abbot Laptook
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Brown University, Providence, RI
| | - Seetha Shankaran
- Department of Pediatrics, Division of Neonatology, Wayne State University, Children's Hospital of Michigan and Hutzel Women's Hospital, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
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18
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Abiramalatha T, Kumar M, Chandran S, Sudhakar Y, Thenmozhi M, Thomas N. Troponin-T as a biomarker in neonates with perinatal asphyxia. J Neonatal Perinatal Med 2018; 10:275-280. [PMID: 28854510 DOI: 10.3233/npm-16119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Troponin-T is a commonly used cardiac biomarker, which could be useful in perinatal asphyxia. We aimed to analyze troponin-T concentrations in asphyxiated neonates and to correlate the concentrations with clinical outcomes. METHODS Data were collected from electronic medical records of neonates diagnosed with perinatal asphyxia over a period of four years. RESULTS There were 63 neonates with moderate to severe encephalopathy, in whom serial troponin-T concentrations had been done on days 1, 3, and 7. 53 (84%) asphyxiated infants had troponin-T concentration >100 pg/ml at 2-4 h of life.The difference in troponin-T concentrations between moderate and severe encephalopathy was not statistically significant (173 vs. 263 pg/ml, p value 0.40). The difference in the concentrations at 72 hours between cooled and non-cooled neonates was not significant (48.5 vs. 62.5 pg/ml, p value 0.22). Troponin-T concentration was significantly higher in babies with hypotensive shock and hepatic injury, but not acute kidney injury. There was no significant correlation between troponin-T and the extent of resuscitation needed.Troponin-T concentration on day 1 of life was significantly higher in babies who died than who survived (407 vs. 168 pg/ml, p value 0.03). ROC curve for troponin-T to predict mortality had an area under the curve (AUC) of 0.803; the best cut-off value (190 pg/ml) had 82% sensitivity and 80% specificity. CONCLUSION There was no significant difference in troponin-T concentrations between cooled and non-cooled neonates. Troponin-T concentration had a good predictive accuracy for mortality before discharge.
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Affiliation(s)
- T Abiramalatha
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - M Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - S Chandran
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Y Sudhakar
- Department of Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - M Thenmozhi
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - N Thomas
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
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19
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Application of Neonatologist Performed Echocardiography in the Assessment and Management of Neonatal Heart Failure unrelated to Congenital Heart Disease. Pediatr Res 2018; 84:78-88. [PMID: 30072802 PMCID: PMC6257223 DOI: 10.1038/s41390-018-0075-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neonatal heart failure (HF) is a progressive disease caused by cardiovascular and non-cardiovascular abnormalities. The most common cause of neonatal HF is structural congenital heart disease, while neonatal cardiomyopathy represents the most common cause of HF in infants with a structurally normal heart. Neonatal cardiomyopathy is a group of diseases manifesting with various morphological and functional phenotypes that affect the heart muscle and alter cardiac performance at, or soon after birth. The clinical presentation of neonates with cardiomyopathy is varied, as are the possible causes of the condition and the severity of disease presentation. Echocardiography is the selected method of choice for diagnostic evaluation, follow-up and analysis of treatment results for cardiomyopathies in neonates. Advances in neonatal echocardiography now permit a more comprehensive assessment of cardiac performance that could not be previously achieved with conventional imaging. In this review, we discuss the current and emerging echocardiographic techniques that aid in the correct diagnostic and pathophysiological assessment of some of the most common etiologies of HF that occur in neonates with a structurally normal heart and acquired cardiomyopathy and we provide recommendations for using these techniques to optimize the management of neonate with HF.
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20
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Rakesh K, Vishnu Bhat B, Adhisivam B, Ajith P. Effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia - a randomized controlled trial. J Matern Fetal Neonatal Med 2017. [PMID: 28629243 DOI: 10.1080/14767058.2017.1344633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia. MATERIAL AND METHODS This randomized controlled trial (RCT) conducted in a tertiary care teaching hospital, south India included 120 newborns with perinatal asphyxia that were randomized to two groups (therapeutic hypothermia and normothermia). Cardiac enzyme profile changes between groups were assessed at 0, 24, 72 h CPK-MB and troponin I levels were estimated by immune inhibition and quantitative immunochromatography methods, respectively. Electrocardiography (ECG) and Echocardiography (ECHO) were done at 0 and 72 h to evaluate the cardiac function and pulmonary hypertension. Neurodevelopment was assessed at 6 months of age in both groups using Developmental Assessment Scales for Indian Infants. RESULTS The median values of CPK-MB in the normothermia and hypothermia groups at 0, 24, and 72 h were 198, 127, and 92 IU/L and 202, 111 and 64 IU/L, respectively. The median values of troponin I in normothermia and hypothermia groups at 0, 24, and 72 hrs were 2.45, 1.53, and 0.9 ng/mL and 1.97, 0.93, and 0.01 ng/mL, respectively. ECG and ECHO findings also suggest lesser myocardial dysfunction in therapeutic hypothermia group compared with the normothermia group. CONCLUSIONS Therapeutic hypothermia significantly decreases the myocardial damage in term asphyxiated neonates.
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Affiliation(s)
- K Rakesh
- a Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
| | - B Vishnu Bhat
- a Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
| | - B Adhisivam
- a Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
| | - P Ajith
- a Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
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21
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Helmer C, Skranes JH, Liestøl K, Fugelseth D. Using adrenaline during neonatal resuscitation may have an impact on serum cardiac troponin-T levels. Acta Paediatr 2015; 104:e378-83. [PMID: 26032882 DOI: 10.1111/apa.13055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/05/2015] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Abstract
AIM It has been suggested that serum cardiac troponin-T (cTnT) can predict the severity of neonatal hypoxic-ischaemic encephalopathy. We evaluated whether cTnT was better correlated with adrenaline during cardiopulmonary resuscitation (CPR) than with the severity of the insult itself, based on the Apgar scores. METHODS Serum cTnT was analysed in 47 asphyxiated newborn infants treated with hypothermia. Blood samples and resuscitation data were collected from medical records, and multiple linear regressions were used to evaluate the effect of the treatment and the Apgar scores on cTnT levels. RESULTS The infants were divided into three groups: the no CPR group (n = 29) just received stimulation and ventilation, the CPR minus adrenaline group (n = 9) received cardiac compression and ventilation and the CPR plus adrenaline group (n = 9) received complete CPR, including adrenaline. In the univariate analysis, the five and ten-minute Apgar scores were significantly lower in the CPR plus adrenaline group and the cTnT was significantly higher. Multiple regression analysis showed significantly higher cTnT values in the CPR plus adrenaline group, but no significant relationship between cTnT and the Apgar scores. CONCLUSION Although cTnT correlated with the severity of the insult in neonatal hypoxic-ischaemic encephalopathy, the levels may have been affected by adrenaline administered during CPR.
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Affiliation(s)
- Caroline Helmer
- Faculty of Medicine; Medical School; University of Oslo; Oslo Norway
| | - Janne H. Skranes
- Department of Neonatal Intensive Care; Oslo University Hospital Ullevål; Oslo Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
| | - Knut Liestøl
- Institute of Informatic; University of Oslo; Oslo Norway
| | - Drude Fugelseth
- Department of Neonatal Intensive Care; Oslo University Hospital Ullevål; Oslo Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
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22
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Abstract
PURPOSE OF REVIEW Hypothermia for neonatal encephalopathy is now the standard of care. The purpose of this review is to evaluate recent publications (during the past 18 months) that impact the practice of hypothermia as neuroprotection for neonatal hypoxic-ischemic encephalopathy. RECENT FINDINGS The review will examine recent publications that influence clinical care, including committee opinion, meta-analysis, and reports of how this practice has evolved in the clinical arena. Biomarkers of acute injury and outcome will be examined. Research involving the future of hypothermia will be noted. SUMMARY The rate of death or disability following hypothermia therapy has been reduced substantially; the challenge is to evaluate whether mortality or disability can be reduced further following combination therapy.
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