Resumen
Introducción: La troponina I (cTnI), la creatina-fosfocinasa (CPK) y la creatina-fosfocinasa-MB (CPK-MB) son biomarcadores cardiacos usados en neonatos con asfixia.
Objetivo: Analizar la relación entre las concentraciones de cTnI, CPK y CPK-MB con los criterios diagnósticos clínicos y bioquímicos de asfixia neonatal.
Métodos: Estudio analítico transversal en neonatos con al menos un criterio diagnóstico de asfixia. Se analizó la relación entre los niveles de cTnI y CPK-MB al nacimiento, niveles séricos de CPK y CPK-MB determinados 24 horas después del parto, con acidosis metabólica, prueba de Apgar a los 5 minutos con puntajes de 0-3, alteraciones neurológicas y/o falla orgánica múltiple.
Resultados: De 34 recién nacidos, el 73.5% nacieron vía cesárea, el 71% eran a término con un peso promedio de 3,096 ± 453 g, en los prematuros el peso fue de 2,275 ± 509 g, y la puntuación de Apgar a los 5 minutos fue de 7.77 ± 1.481 y 7.03 ± 1.705, respectivamente. El 17.6% de los neonatos tuvieron un pH < 7.20, el 58% un déficit de base < 12 mmol/l, el 5.8% Apgar < 3 a los 5 minutos y el 38.23% alteraciones neurológicas o falla orgánica múltiple. El 100% de los recién nacidos tuvieron unos valores de cTnI normales. La CPK y la CPK-MB a las 24 horas se encontraron alteradas en un 29% con uno o dos criterios de asfixia. El porcentaje de CPK-MB se asoció con la edad gestacional.
Conclusiones: La cTnI fue normal en los neonatos con sospecha de asfixia, pero no así la CPK y la CPK-MB, que pueden elevarse en estos pacientes, principalmente en los nacidos pretérmino. Los marcadores bioquímicos no se asociaron con ninguno de los parámetros clínicos.
Abstract
Background: The cardiac troponin I (cTnI), creatine phospokinase (CPK), and creatine kinase- myocardial band (CK-MB) are cardiac biomarkers used in newborns with asphyxia.
Objective: To analyze the relationship between cTnI, CPK and CPK-MB levels with clinical and biochemical diagnostic criteria for neonatal asphyxia.
Methods: Analytical cross-sectional study in neonates with at least one diagnostic criterion of asphyxia. Relationship among cTnI and CPK-MB levels at birth, serum levels of CPK and CPK-MB determined 24 hours after delivery, with metabolic acidosis, Apgar test at 5 minutes with scores of 0-3, neurological alterations and/or multiple organ failure were analyzed.
Results: Thirty-four neonates, 73.5% born by cesarean section, 71% term neonates with a mean weight of 3,096 ± 453g, 2,275 ± 509g for preterm, and a mean of 7.77 ± 1.481 and 7.03 ± 1.705 5-minute Apgar score, respectively. 17.6% of the neonates reported a pH value < 7.20, 58% a base deficit of 12 mmol/L, 5.8% obtained a 5-minute Apgar score < 3, and 38.23% had neurological alterations and/or multiple organ dysfunction syndrome. All patients reported cTnI within the normal reference range. CPK and CPK-MB values, 24 hours after delivery, were elevated in 29% of the cases with one or two diagnostic criteria for neonatal asphyxia. The percentage of CPK-MB was associated with gestational age.
Conclusions: cTnI values were normal in suspected cases of neonatal asphyxia, whereas CPK and CPK MB can elevate in these population, principally in preterm newborns. Biochemical markers were not associated with any clinical parameter.
Antonucci R, Porcella A, Pilloni MD. Perinatal asphyxia in the term newborn. J Pediatr Neonat Individual Med. 2014;3(2):e030269. doi: 10.7363/030269.
Azra-Haider B, Bhutta ZA. Birth asphyxia in developing countries: current status and public health implications. Curr Probl Pediatr Adolesc Health Care. 2006;36(5):178- 88. doi: 10.1016/j.cppeds.2005.11.002.
Clark SJ. Concentrations of cardiac troponin T in neonates with and without respiratory distress. Arch Dis Child Fetal Neonatal. 2004;89(4):F348-52. doi: 10.1136/ adc.2002.025478.
Eerola A, Poutanen T, Savukoski T, Pettersson K, Sairanen H, Jokinen E, et al. Cardiac troponin I, cardiac troponin specific autoantibodies and natriuretic peptides in children with hypoplastic left heart syndrome. Interact Cardiovasc Thorac Surg. 2014;18(1):80-5. doi: 10.1093/ icvts/ivt430.
Baum H, Hinze A, Bartels P, Neumeier D. Reference values for cardiac troponins T and I in healthy neonates. Clin Biochem. 2004;37(12):1079-82. doi: 10.1016/j.clinbiochem.2004.08.003.
Zhou WJ, Yu F, Shi J, Yang H, Zou SJ, Jiang YM. Serum levels of cardiac troponin I in asphyxiated neonates predict mortality. Clin Lab. 2016;62(8):1427-34. doi: 10.7754/ Clin.Lab.2016.151130.
Türker G, Babaoğlu K, Duman C, Gökalp A, Zengin E, Arisoy AE. The effect of blood gas and Apgar score on cord blood cardiac troponin I. J Matern Fetal Neonatal Med. 2004;16(5):315-9. 10.1080/14767050400017991.
Sarko J, Pollack CV. Cardiac troponins. J Emerg Med. 2002;23(1):57-65. doi: https://doi.org/10.1016/S0736- 4679(02)00463-8.
Soldin SJ, Murthy JN, Agarwalla PK, Ojeifo O, Chea J. Pediatric reference ranges for creatine kinase, CKMB, troponin I, iron, and cortisol. Clin Biochem. 1999;32(1):77- 80. doi: 10.1016/s0009-9120(98)00084-8.
Sadoh WE, Eregie CO, Nwaneri DU, Sadoh AE. The diagnostic value of both troponin T and creatinine kinase isoenzyme (CK-MB) in detecting combined renal and myocardial injuries in asphyxiated infants. PLoS One. 2014;9(3):e91338. doi: 10.1371/journal.pone.0091338.
Sobki SH, Saadeddin SM, Habbab MA. Cardiac markers used in the detection of myocardial injury. Saudi Med J. 2000;21(9):843-6.
Rajakumar PS, Bhat BV, Sridhar MG, Balachander J, Konar BC, Narayanan P, et al. Cardiac enzyme levels in myocardial dysfunction in newborns with perinatal asphyxia. Indian J Pediatr. 2008;75(12):1223-5. doi: 10.1007/s12098-008-0242-z.
Boo NY, Hafidz H, Nawawi HM, Cheah FC, Fadzil YF, Abdul-Aziz BB, et al. Comparison of serum cardiac troponin T and creatine kinase MB isoenzyme mass concentrations in asphyxiated term infants during the first 48 h of life. J Paediatr Child Health. 2005;41(7):331-7. doi: 10.1111/j.1440-1754.2005.00626.x.
Hussien NF, Ghany EA, Elwan EA, Kamel YH, Ali DK. Comparison of serum cardiac troponin-I and creatine kinase MB isoenzyme concentrations in asphyxiated neonates. Int J Med. 2008;1(4):150-4. doi: 10.1111/j.1440-1754.2005.00626.x.
Li J,Yuning L, Zhi Z, Lixing L, Xiaoli L. Use of high-sensitivity cardiac troponin I levels for early diagnosis of myocardial injury after neonatal asphyxia. J Int Med Res. 2019;47(7):3234-42. doi: 10.1177/0300060519831187.
Yildirim A, Ozgen F, Ucar B, Alatas O, Tekin N, Kilic Z. The diagnostic value of troponin T level in the determination of cardiac damage in perinatal asphyxia newborns. Fetal Pediatr Pathol. 2016;35(1):29-36. doi: 10.3109/15513815.2015.1122128.
Blum D, Brauman J. Serum enzymes in the neonatal period. Diagnostic aid in muscle pathology. Biol Neonate. 1975;26(1-2):53-7.
Barbosa-Adauto DM, Goldani MPS, Figueiredo I, Kanaan S. Is the creatine kinase isoenzyme MB level a marker of myocardial ischemia in ventilated premature infants? J Bras Patol Med Lab. 2016;52(4):223-6. doi: https://doi.org/10.5935/1676-2444.20160037.
Bader D, Kugelman A, Lanir A, Tamir A, Mula E, Riskin A. Cardiac troponin I serum concentrations in newborns: a study and review of the literature. Clin Chim Acta. 2006;371(1-2):61-5. doi: 10.1016/j.cca.2006.02.018.
Szymankiewicz M, Matuszczak-Wleklak M, Vidyasagar D, Gadzinowski J. Retrospective diagnosis of hypoxic myocardial injury in premature newborns. J Perinat Med. 2006;34(3):220-5.
Gaze DC, Collinson PO. Cardiac troponin I should be interpreted with caution in paediatric neonatal patients. Concerning Turker et al.: ‘Cord blood cardiac troponin i as an early predictor of short-term outcome in perinatal hypoxia’. Biol Neonate. 2005;87(1):19. doi: 10.1159/ 000080890.
Gaze DC, Collinson PO. Interpretation of cardiac troponin measurements in neonates – the devil is in the details. Commentary to Trevisanuto et al.: Cardiac troponin I in asphyxiated neonates (Biol Neonate 2006;89:190–193). Biol Neonate. 2006;89(3):194-6. doi: 10.1159/000089549.
Siddiq A, Krisnadi SR, Effendi JS. The differences of cord blood troponin I (TnI) level between normal and asphyxiated infants and its correlation with APGAR score. Open J Obstet Gynecol. 2014;4(15):954-60. doi: 10.4236/ojog.2014.415134.
Lee ST, Shen CM, Nar M, Kua KE, Lin LH. CK, CK-MB, troponin-I levels in perinatal asphyxiated infants during the first four hours of life: a retrospective study. Clin Neonatol. 2006;13(2):51-4. doi: 10.1007/0-387-26336-5_318.
Trevisanuto D, Picco G, Golin R, Doglioni N, Altinier S, Zaninotto M, et al. Cardiac troponin I in asphyxiated neonates. Biol Neonate. 2006;89(3):190-3. doi: 10.1159/ 000089795.
Singh V, Vohra R, Bansal M. Cardiovascular involvement in birth asphyxia. J Clin Neonatol. 2018;7:20-4.
Rajakumar PS, Vishnu Bhat B, Sridhar MG, Balachander J, Konar BC, Narayanan P, et al. Electrocardiographic and echocardiographic changes in perinatal asphyxia. Indian J Pediatr. 2009;76(3):261‐4. doi: 10.1007/s12098-008-0221-4.
Agrawal J, Shah GS, Poudel P, Baral N, Agrawal A, Mishra OP. Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy. Ital J Pediatr. 2012;38:39.
Shadique AM, Sailavasan M. A prospective study on cardiac changes (electrocardiographic, enzymatic and echocardiographic) in birth asphyxiated neonates admitted in tertiary care centre. Int J Contemp Pediatr. 2019;6(2):269-74.
Kanik E, Ozer EA, Bakiler AR, Aydinlioglu H, Dorak C, Dogrusoz B, et al. Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: is it a significant predictor of mortality? J Martern-Fetal Neo M. 2009;22(3):239-42.