Use of cardiac biomarkers in neonatology

The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed access to MEDLINE citations; http://www.ncbi.nlm.nih.gov/PubMed/ ). The search strategy included the following medical subject headings and text terms for the key words: "cardiac injury biomarkers", "creatine kinase-MB", "myoglobin", "troponin", "children", "neonate/s", "newborn/s", "infant/s" and echocardiography. 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. Elevation of cardiac injury biomarkers may also have diagnostic value in cases when cardiac contusion or pericarditis is suspected. Cardiac injury biomarkers are very sensitive markers for the detection of myocardial injury and have been studied in healthy newborns, after tocolysis, intrauterine growth restriction, respiratory distress and asphyxia. The proportion of newborns with elevated troponin was higher than that in ill infants, children, and adolescents and in healthy adults, suggesting that myocardial injury, although clinically occult, is common in this young age group. Results suggest that significant elevation of cord troponin is an excellent early predictor of severity of hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac biomarkers may also benefit centres without on-site echocardiography with evidence showing good correlation with echo-derived markers of myocardial function. Further studies are needed to better clarify the role of cardiac biomarkers in paediatric age and their correlation with echocardiographic parameters.

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“…Further research is necessary before cardiac injury biomarkers can be used in clinical practice in this age group [64,65].…”

Section: Cardiac Injury Biomarkers In the Cord Bloodmentioning

confidence: 99%

Cardiac injury biomarkers in paediatric age: Are we there yet?

et al. 2016

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“…Este valor elevado encontrado en RN sanos durante los primeros días de vida tiende a normalizarse en forma conjunta con el descenso fisiológico de peso y alcanza valores similares a los observados en adultos. [5][6][7] En la población neonatal, existe una amplia variabilidad en los dosajes de PNB. Varios estudios reportan valores de PNB de entre 200 y 6000 pg/mL.…”

Section: Introductionunclassified

Péptido natriurético tipo B: utilidad en el manejo de recién nacidos críticamente enfermos

et al. 2017

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RESUMENEl péptido natriurético B (PNB) es un péptido responsable de los cambios durante la organogénesis del corazón y en la transición a la vida extrauterina. En la primera semana de vida, los niveles de PNB son altos y se normalizan con el descenso fisiológico del peso. Valores elevados de PNB se han asociado a diferentes patologías. Objetivo. Establecer la relación entre los niveles de PNB y la criticidad y evolución a corto plazo en pacientes internados en la Unidad de Cuidados Intensivos Neonatales. Método. Estudio observacional analítico de una cohorte prospectiva. Se definió criticidad como requerimientos de asistencia respiratoria con fracción inspirada de oxígeno mayor del 50% y/o inotrópicos. Se extrajeron 2 muestras de sangre con 72 h de diferencia. Resultados. Ingresaron 73 pacientes. Según la evolución al séptimo día del ingreso, se los dividió en 2 grupos: pacientes con buena evolución o con evolución grave persistente. La mediana del PNB inicial fue similar en ambos grupos (p: 0,15). La mediana de PNB a las 72 h fue mayor en los pacientes con evolución grave persistente (p: 0,005). Se calculó la diferencia entre ambos valores de PNB (∆PNB: valor de PNB a las 72 h -valor de PNB a la hora cero). El ∆PNB presentó valores positivos en los pacientes con evolución grave persistente (X= 1260 pg/ml; rango: 426-2094) y valores negativos en el grupo con buena evolución (X= -967 pg/ml; rango: -1656/-278) (p: 0,0002); sensibilidad: 87%; especificidad: 86%; valor predictivo positivo: 74%; y valor predictivo negativo: 93%. Conclusión. En este grupo de pacientes, el delta de PNB reflejó la evolución a corto plazo. Palabras clave: péptido natriurético B, recién nacido.

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“…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.…”

mentioning

confidence: 99%

Is it Possible to Predict Mortality in Preterm Neonates, Based on a Single Troponin I Value at 24 h?

et al. 2015

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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.

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Use of cardiac biomarkers in neonatology

Cited by 46 publications

References 77 publications

Cardiac injury biomarkers in paediatric age: Are we there yet?

Cardiac injury biomarkers in paediatric age: Are we there yet?

Péptido natriurético tipo B: utilidad en el manejo de recién nacidos críticamente enfermos

Is it Possible to Predict Mortality in Preterm Neonates, Based on a Single Troponin I Value at 24 h?

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