Jul 3, 2012 - asphyxiated full-term neonates using their serum cardiac troponin T levels. Methods: In all, 30 ... serum cardiac troponin T was done within the first 4 to 24 hours of life. Results: ..... Nearly half of these latter participants had.
World Journal for Pediatric and Congenital Heart Surgery http://pch.sagepub.com/
Serum Cardiac Troponin T in Asphyxiated Term Neonates Delivered at Two Teaching Hospitals in Lagos, Nigeria Chinyere C. Uzodimma, Christy A. N. Okoromah, Ekanem Ekure, Chinyere V. Ezeaka and Fidelis O. Njokanma World Journal for Pediatric and Congenital Heart Surgery 2012 3: 330 DOI: 10.1177/2150135112442693 The online version of this article can be found at: http://pch.sagepub.com/content/3/3/330
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Original Article
Serum Cardiac Troponin T in Asphyxiated Term Neonates Delivered at Two Teaching Hospitals in Lagos, Nigeria
World Journal for Pediatric and Congenital Heart Surgery 3(3) 330-336 ª The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150135112442693 http://pch.sagepub.com
Chinyere C. Uzodimma, MBBS, FWACP1, Christy A. N. Okoromah, MBBS, FMCPaed1, Ekanem Ekure, MBCHB, FWACP1, Chinyere V. Ezeaka, MBBS, FWACP 1, and Fidelis O. Njokanma, MBBS, FMCPaed, FWACP2
Abstract Background: Asphyxia is a leading cause of perinatal morbidity and mortality in the developing countries. All organs including the myocardium are vulnerable to ischemic injury in asphyxia. The aim of the current study was to assess myocardial injury in asphyxiated full-term neonates using their serum cardiac troponin T levels. Methods: In all, 30 term asphyxiated neonates and 30 gestational age-, birth weight-, and sex-matched controls were studied. Asphyxia was defined by double criteria of low umbilical arterial blood pH 6. The umbilical arterial pH was done soon after delivery, while the serum cardiac troponin T was done within the first 4 to 24 hours of life. Results: Participants and controls were similar in terms of mean gestational age, mode of delivery, gender, and birth weight (P ¼ 1.0, .07, 1.0, and 1.0, respectively). Two thirds of the asphyxiated babies had elevated serum cardiac troponin T in the high risk range (> 0.1 ng/mL). On the contrary, none of the controls had serum cardiac troponin T in that range. Serum cardiac troponin T showed negative correlation with pH (r ¼ .75), fiveminute Apgar score (r ¼ .74), and one-minute Apgar score (r ¼ 0.70). Conclusion: The study identified perinatal asphyxia as a high-risk factor for elevated serum cardiac troponin T and hence for myocardial cellular injury. Keywords neonates, asphyxia, troponin T, myocardial injury Submitted September 17, 2011; Accepted February 16, 2012. Presented at Cardiology 2011, 15th annual update on Paediatric and Congenital Cardiovascular Diseases: Bringing Interdisciplinary Evidence-Based Practice to the Patient, Arizona, USA; February 26, 2011. PASCAR conference, Munyoyo, Uganda; May 26-30, 2011.
Introduction Worldwide, in the year 2000, complications of asphyxia together with preterm birth and severe infection accounted for 86% of the neonatal deaths and more than three quarters of these deaths occurred in the first week after birth.1 Likewise, in Nigeria, perinatal asphyxia is one of the leading causes of neonatal deaths. Studies in Nigeria have found an incidence of asphyxia between 100 and 180 per thousand live births and accounting for 16% to 55% of neonatal deaths.2-7 ‘‘Perinatal asphyxia’’ refers to hypoxic or ischemic insult to the fetus or new born that is of sufficient magnitude and duration to cause more than fleeting biochemical or functional changes.8 Apgar score has been shown to correlate with asphyxia. It is a scoring method described by Virginia Apgar which assesses the condition (respiration, heart rate, color, tone, and reflex activity) of the newborn at birth.9 A well baby would have a score of 7 and above and the asphyxiated neonate will often have low Apgar score of 6 and below.9-11
Acidosis is always present in perinatal asphyxia and can be reliably assessed by the blood pH. Previous studies have defined asphyxia with cutoff values of umbilical arterial blood pH
