To the Editor: An early detection of post-asphyxia syndrome in preterm neonates is very difficult; especially when it is known that a low Apgar score (AS) is not always a consequence of perinatal asphyxia [1,2]. There are insufficient number of studies, linking bad outcome of post-asphyxia with serum concentrations of cardiac troponins in neonates, and their values have not been precisely defined [3][4][5].The experimental group in our study consisted of 45/70 male and 25/70 female preterm neonates; gestational age 31.7±3.36 wk; body weight 1849±699.09 g; 5-min AS 5 (5-7); lactate levels in the first 6 h after birth 5.5 (4.4-8.2) mmol/L. Primary resuscitation was required in 25/70, the use of inotropes in 34/70 and conventional mechanical ventilation in 51/70 patients. The outcome was fatal in 12/70.The control group consisted of 23/38 males and 15/38 females, gestational age 32.4±3.25 wk; body weight 1957± 687.45 g; 5-min AS 8 (8-8); lactate levels 0.9 (0.8-1.2) mmol/L. All patients only required basic intensive care (diffuse oxygen in the incubator FiO 2 <40 %).Cardiac troponin-I ultra (CTNU) values at 24 h were significantly higher in the experimental group: 0.02 (0.01-0.062) mcg/L, when compared to the control group: 0.01 (0.01-0.01), while CTNU values did not correlate significantly with serum lactate (r=0.191, p=0.121) and 5-min AS (r=0.05, p=0.683) ( Table 1).Hypotensive patients had significantly higher levels of CTNU (median 0.04 mcg/L; 0.01 to 0.13 mg/L, p=0.009) compared to those without inotropic therapy (0.01 mcg/L; 0.01-0.037 mcg/L). CTNU was negatively correlated with ejection fraction (EF) of left ventricle [63.18 % (47.5-74.11); r=−0.479; p=0.0005], while there was no significant difference between ventilated (respiratory distress was 62/70) and non-ventilated subjects (r=0.356).Increase of CTNU >0.045 mcg/L was a significant predictor of fatal outcomes [Confidence Interval 79 %; sensitivity 66.7 %; specificity 79.3 %; positive predictive value (PPV) 91.8 %; negative predictive value (NPV) 38.