Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy

Abstract

BackgroundPerinatal asphyxia leading to hypoxic-ischemic encephalopathy (HIE) is a common problem causing multi organ dysfunction including myocardial involvement which can affect the outcome.ObjectiveTo evaluate the myocardial dysfunction in neonates having HIE by electrocardiographic(ECG) and cardiac enzymes (CK Total, CK-MB and Troponin I) and find out the relationship with HIE and outcome.Design/MethodsThis was a hospital based prospective study. Sixty term neonates who had suffered perinatal asphyxia and developed HIE were enrolled. Myocardial involvement was assessed by clinical, ECG, and CK Total, CK-MB and Troponin I measurements.ResultsOf 60 cases, 13(21.7%) were in mild, 27(45%) in moderate and 20(33.3%) belonged to severe,HIE. ECG was abnormal in 46 (76.7%); of these 19 (41.3%) had grade I, 13 (28.2%) grades II and III each and 1 (2.1%) with grade IV changes. Serum levels of CK Total, CK- MB and Troponin I were raised in 54 (90%), 52 (86.6%) and 48 (80%) neonates, respectively. ECG changes and enzymatic levels showed increasing abnormalities with severity of HIE, and the differences among different grades were significant (p = 0.002, 0.02, <0.001 and 0.004, respectively). Nineteen (32%) cases died during hospital stay. The non- survivors had high proportion of abnormal ECG (p = 0.024), raised levels of CK-MB (p = 0.018) and Troponin I (p = 0.008) in comparison to survivors.ConclusionsAbnormal ECG and cardiac enzymes levels are found in HIE and can lead to poor outcome due to myocardial damage Early detection can help in better management and survival of these neonates.

A biochemical profile of cardiac involvement in perinatal asphyxia

“…11 There was a linear relation between the severity of asphyxia as assessed by HIE grading and the CK-MB values. The Percentage of babies with grade three HIE was similar to Rajkumar PS et al, Karnik E et al whereas HIE grade 3 was higher in Jyoti et al 10,12,13 In present study, there was no significant difference in CK-MB values between HIE 1 and 2, whereas between HIE 1 and 3 the rise was statistically significant showing that evaluation of enzymes can be a good tool to assess the severity of HIE. In a study conducted by Merchant S et al also there was a significant difference between HIE1 and 3 ( Table 8).…”

“…10,12,13 This may be due to great variation in Twave changes in normal babies in the first week of life. The ECG changes observed in asphyxiated babies is similar to those observed in Rajkumar PS et al, except that in their study, Grade 2 changes were more.…”

“…In Jyoti et al, the ECG changes were classified based on Jedikien classification and Grade 1 changes which are nonspecific. 13,15 …”

Therapeutic hypothermia and myocardium in perinatal asphyxia: a microvolt T-wave alternans and Doppler echocardiography study

“…The infl uence of hypoxemia is related to myocardial dysfunction in asphyxiated neonates and is thought to be secondary to direct effect of ischemia of cardiac myocytes (20). Thus, changes in ECG may be seen as a result of myocardial hypoxia in asphyxiated newborns.…”

Prediction of Hie by Nucleated Rbc’s in Cord Blood, Serum Creatine Kinase and Assessment of Outcome by Follow Up Upto 6 Months

“…A study by Agrawal et al 8 and D H Karunatilaka 9 had shown that creatine kinase increases in asphyxiated group and that the level of rise is proportionate to the stage of HIE. In our study the CK value also varied with different stages of HIE.…”