doiSerbia

The significance of second generation cardiac troponin I in early screening of hypoxic-ischemic encephalopathy after perinatal asphyxia

Simović Aleksandra M. (Klinika za pedijatriju, Klinički centar „Kragujevac“, Kragujevac + Medicinski fakultet, Kragujevac)
Igrutinović Zoran (Klinika za pedijatriju, Klinički centar „Kragujevac“, Kragujevac + Medicinski fakultet, Kragujevac)
Obradović Slobodan (Klinika za pedijatriju, Klinički centar „Kragujevac“, Kragujevac + Medicinski fakultet, Kragujevac)
Ristić Dragana (Klinika za pedijatriju, Klinički centar „Kragujevac“, Kragujevac)
Vuletić Biljana (Klinika za pedijatriju, Klinički centar „Kragujevac“, Kragujevac + Medicinski fakultet, Kragujevac)
Radovanović Marija (Klinika za pedijatriju, Klinički centar „Kragujevac“, Kragujevac + Medicinski fakultet, Kragujevac)

Introduction. In the last few years the use of cardiac troponin I and T, as diagnostic and prognostic factors of ischemic myocardial injury both in adult and neonatal medicine has been of great interest. Objective. The objective of our research was to investigate the significance of cardiac troponin I (sTnI) as an early indicator of the presence and severity of hypoxic-ischemic encephalopathy (HIE) in newborns. Methods. We analyzed 55 term newborns with HIE diagnosed based on clinical findings and ultrasonographic examination of the central nervous system. Serum concentration of sTnIultra was determined by immunoenzyme method during the first 24-48 hours after birth, and the obtained findings were compared with the values of identical parameter in 36 healthy term newborns. Results. During the first 24-48 hrs after birth, serum concentration of sTnI-ultra was significantly higher (r<0.0005) in term newborns with HIE (0.135±0.207 μg/l) and median (0.07, 0.01- 006 μg/l) in comparison to control group (0.0183±0.026 μg/l and median 0.01 (0.01-0.01 μg/l), with the sTnI-ultra level rising proportionally to the clinical HIE stages. The increase of sTnI-ultra of >0.12 μg/l indicated the development of significant cerebral damage with the sensitivity of 75% and specificity of 72.2%, while the sTnI-ultra level of >0.13 μg/l was a significant mortality predictor with sensitivity of 76.9% and specificity of 73.8%. Conclusion. The second generation cardiac troponin I assay highly correlates with clinical and ultrasonographic findings in neonates with HIE, so that it can be used as a significant diagnostic and prognostic indicator of this pathological condition.

Keywords: hypoxic-ischemic encephalopathy, troponin I, newborn, prognosis