Aim: To determine the value of cord blood cardiac troponin I levels (cTnI) as an early prognostic factor in critically ill newborns, and to compare cord cTnI levels with the prognostic value of the score for neonatal acute physiology (SNAP).
Methods: Cord arterial samples were collected routinely for blood gas analysis, and cord venous samples for cTnI and cardiac-specific creatine kinase assay. The study group (n=109) comprised critically ill newborns who required mechanical ventilation. The control group (n=96) comprised newborns who were either completely healthy (n=48) or were followed in a level I neonatal care unit due to moderate-severity problems.
Results: The critically ill newborns had significantly higher cTnI levels than control babies (median [min-max] 1.4 [0–13] vs. 0 [0–1.8] ng/mL, respectively; P<0.001). In critically ill newborns, non-survivors had significantly higher cTnI levels than survivors (median [min-max] 6.6 [1.3–13.0] vs. 1.3 [0–8.0] ng/mL, respectively; P<0.001). Receiver-operator curve analysis revealed that, compared with SNAP, cTnI was a more sensitive predictor of mortality in critically ill newborns (area under curve=0.96; 95% CI=0.90–1.02).
Conclusion: Significantly elevated cord cTnI may be a valuable predictor of mortality in critically ill newborns.
1 Adamcova M, Z Kokstein, V Palicka, M Podholova, M Kostal: Troponin T levels in neonates after acute and long-term tocolysis. Physiol Res44 (1995) 8 Search in Google Scholar
2 Adamcova M, Z Kokstein, V Palicka, J Vavrova, M Kostal, M Podholova, et al.: Cardiac troponin T in pregnant women having intravenous tocolytic therapy. Arch Gynecol Obstet262 (1999) 121 Search in Google Scholar
3 Adamcova M, Z Kokstein, A Voseckova, M Podholova, J Podzimkova: Vliv tokolytic na kardiovaskularnı sysytem matky plodu a novorozence. Cs Gynek58 (1993) 306 Search in Google Scholar
4 Barrow MW: The syndrome of preeclampsia. Gastroenterol Clin North Am21 (1992) 851 Search in Google Scholar
5 Benedetti TJ: Maternal complications of parenteral betasymphathomimetic therapy for premature labour. Am J Obstet Gynecol145 (1983) 1 Search in Google Scholar
6 Bertsch T, C Janke, C Denz, M Weiss, T Luiz, K Ellinger, et al.: Cardiac troponin I and cardiac troponin T increases in pigs during ischemia-reperfusion damage. Exp Toxicol Pathol52 (2000) 157 Search in Google Scholar
7 Bhayana V, AR Henderson: Biochemical markers of myocardial damage. Clin Biochem28 (1995) 1 Search in Google Scholar
8 Clark SJ, P Newland, CW Yoxall, NV Subhedar: Concentrations of cardiac troponin T in neonates with and without respiratory distress. Arch Dis Child Fetal Neonatal Ed89 (2004) F348 Search in Google Scholar
9 Engin Y, Y Üstün, G Kurtay: Cardiac troponin I levels in umbilical cord blood. Int J Gynaecol Obstet77 (2002) 239 Search in Google Scholar
10 Genser N, H Ellemunter, J Mair, et al.: Cardiac troponin T and CKMB mass concentrations in asphyxiated neonates (abstract). Clin Chem40 (1994) 1113 Search in Google Scholar
11 Hirsch R, Y Landt, S Porter, CE Canter, AS Jaffe, JH Ladenson, et al.: Cardiac troponin I in pediatrics: normal values and potential use in the assessment of cardiac injury. J Pediatr130 (1997) 77 Search in Google Scholar
12 Keffler JH: Myocardial markers of injury. Evaluation and insights. Am J Clin Pathol105 (1996) 305 Search in Google Scholar
13 Kokstein Z, M Adamcova, V Palica: Troponin T in the cord blood – marker of myocardial injury after tocolysis. J Mol Cell Cardiol27 (1995) A87 Search in Google Scholar
14 Moller J, B Thielsen, TF Schaible, I Reiss, M Kohl, T Welp, et al.: Value of myocardial hypoxia markers (creatine kinase and its MB fraction, troponin T, QT intervals) and serum creatinine for the retrospective diagnosis of perinatal asphyxia. Biol Neonate73 (1998) 367 Search in Google Scholar
15 Narin N, Ç Neşide, H Kılıç, M Başbuğ, F Narin, M Kafalı, et al.: Diagnostic value of troponin T in neonates of mild pre-eclamptic mothers. Biol Neonate75 (1999) 137 Search in Google Scholar
16 Prellwitzh W, G Hafner, HJ Rupprecht, J Meyer: Diagnostic and differential diagnostic value of troponins. Med Klin91 (1996) 336 Search in Google Scholar
17 Richardson DK, JE Gray, MC McCormick, K Workman-Daniels, DA Goldman: Score for neonatal acute physiology: a physiologic severity index for neonatal intensive care. Pediatrics91 (1993) 617 Search in Google Scholar
18 Sasse S, NJ Brand, P Kyprianou, GK Dhoot, R Wade, M Arai, et al.: Troponin I gene expression during human cardiac development and in end-stage heart failure. Circ Res72 (1993) 932 Search in Google Scholar
19 Trevisanuto D, M Lachin, PA Pellegrino, M Plebani, F Cantarutti, V Zanardo: Cardiac troponin T in newborn infants with transient myocardial ischemia. Biol Neonate73 (1998) 161 Search in Google Scholar
20 Trevisanuto D, M Pitton, N Doglioni, S Altinier, M Zaninotto, M Plebani, et al.: Cord blood cardiac troponin I in multiple gestation neonates. Biol Neonate85 (2004) 269 Search in Google Scholar
21 Türker G, K Babaoğlu, AS Gökalp, N Sarper, E Zengin, AE Arısoy: Cord blood cardiac troponin I as an early predictor of short-term outcome in perinatal hypoxia. Biol Neonate86 (2004) 131 Search in Google Scholar
22 Turner A, M Tsamitros, R Bellomo: Myocardial cell injury in septic shock. Crit Care Med27 (1999) 1775 Search in Google Scholar
23 Wright RS, BA Williams, H Crammer, F Gallahue, T Willmore, L Lewis, et al.: Elevations of cardiac troponin I are associated with increased short-term mortality in non-cardiac critically ill emergency department patients. Am J Cardiol90 (2002) 634 Search in Google Scholar
©2005 by Walter de Gruyter Berlin New York