Cardiac Troponin T in Neonates after Acute and Long-Term Tocolysis

Background: Perinatal asphyxia constitutes a significant problem influencing neonatal mortality and morbidity. Objectives: The aim of the present work was to provide evidence of the usefulness of cardiac troponin T (cTnT) and echocardiographic investigations in the diagnosis of heart damage in full-term infants after intrauterine hypoxia. Material and Methods: The subjects were 39 asphyxiated and 44 term infants without fetal anoxia. Quantitative determinations of cTnT were performed between 12 and 24 h of life. Two-dimensional Doppler and color Doppler studies were performed at the bedside. We evaluated fractional shortening (FS), cardiac output (CO), cardiac index (CI), tricuspid (TI) and mitral (MI) insufficiency. Results: Asphyxiated infants presented increased cTnT (mean 0.141 ± 0.226 vs. 0.087 ± 0.111ng/ml; p < 0.01) and TI (38.5 vs. 11.4% of population; p < 0.05) compared to healthy infants. CO, CI and FS remained in the same range. Conclusions: We found cTnT to be the most useful among accessible diagnostic tools used in post-hypoxic heart damage in neonates. The data from our relatively small population study suggest a cTnT value of >0.1 ng/ml as a reliable marker of myocardial injury in neonates. Further study should be performed to generate a receiver-operator characteristic curve to discover what the cut-off level should be.

Section: Discussionmentioning

confidence: 88%

“…0.10 ng/ml in healthy fullterm patients. Both, Adamcova et al [27] and Makikallio et al [26] used an old-generation assay which differs in calibration material and assay performance compared to the third-generation assay used in our study.…”

Section: Discussionmentioning

confidence: 94%

Usefulness of Cardiac Troponin T and Echocardiography in the Diagnosis of Hypoxic Myocardial Injury of Full-Term Neonates

Szymankiewicz

Matuszczak-Wleklak²,

Hodgman³

et al. 2005

“…Adamcova et al [44] showed a higher cTnT levels in infants following tocolysis (0.24 8 0.05 vs. 0.05 8 0.01 g/l). These studies used second-generation troponin T assays and included small numbers.…”

Section: Influence Of Other Factors On Troponinmentioning

confidence: 94%

Serum Troponin in Neonatal Intensive Care

El-Khuffash

Molloy

2007

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.

“…Therefore, it is favorable in detecting minor amounts of cardiac necrosis that could be missed by other markers [6,10] . Third, despite a biological half-life of 2 h [6,10,11] , cTnT has a wide diagnostic time window in adults ranging from few hours till 14-21 days with a peak at 12 h as a consequence of intracellular compartmentation [2,6,[9][10][11][12][13][14] .…”

mentioning

confidence: 99%

Cardiac Troponin T: A Useful Early Marker for Cardiac and Respiratory Dysfunction in Neonates

Awada

Al-Tannir²,

Ziade³

et al. 2007

Background: Cardiac troponin T (cTnT) has been proposed as specific biochemical marker for myocardial infarction in adults. Cardiac function in neonates could be influenced by the severity of respiratory distress and its ventilatory management. Objectives: To establish a normal range of cTnT in healthy neonates, compare troponin concentrations among healthy neonates and those in respiratory distress (sick) and detect whether any correlation occurs between severity of respiratory distress and troponin concentrations. Methods: Concentrations of cTnT were compared between sick and healthy infants, accountingfor confounding variables in a prospective investigation manner. Age at sampling, need for ventilation, durationof respiratory support, and inotropic use in addition to neonatal and maternal characteristics were assessed. Results: Samples were collected from164 neonates (116 healthy and 48 sick).The medians [interquartile ranges] of cTnT in healthy and sick infants were 0.044 [0.027–0.073]µg/l and 0.121 [0.065–0.238] µg/l, respectively, with p < 0.0001. The 99th percentile for healthy neonates was 0.244 µg/l. Comparing both groups, there were significantdifferences concerning gestation, birth weight, Apgar at 5 min and admission to neonatal intensive care unit. Troponin concentrations in subgroups of sick infants including hypotensive, ventilated and dead infants were higher than other infants of the same subgroup. CTnT was positively correlated to the duration of respiratory support in ventilated neonates. Conclusion: CTnT may prove to be a useful early marker for cardiac and respiratory dysfunction in newborns.