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

Abstract

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. The objective of our research was to investigate the significance of cardiac troponin I (cTnl) as an early indicator of the presence and severity of hypoxic-ischemic encephalopathy (HIE) in newborns. We analyzed 55 term newborns with HIE diagnosed based on clinical findings and ultrasonographic examination of the central nervous system. Serum concentration of cTnl-ultra 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. During the first 24-48 hrs after birth, serum concentration of cTnI-ultra was significantly higher (p < 0.0005) in term newborns with HIE (0.135 +/- 0.207 microg/l) and median (0.07, 0.01-006 microg/l) in comparison to control group (0.0183 +/- 0.026 microg/l and median 0.01 (0.01-0.01 microg/l), with the cTnl-ultra level rising proportionally to the clinical HIE stages. The increase of cTnI-ultra of > 0.12 microg/l indicated the development of significant cerebral damage with the sensitivity of 75% and specificity of 72.2%, while the cTnI-ultra level of > 0.13 microg/l was a significant mortality predictor with sensitivity of 76.9% and specificity of 73.8%. 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.