Comparison of serum Cardiac Troponin I and Creatine Kinase MB concentrations in Perinatal Asphyxia
Journal Title: Journal of Medical Science And clinical Research - Year 2015, Vol 3, Issue 5
Abstract
Background: Perinatal asphyxia considered one of the most important causes of neonatal morbidity and mortality. Perinatal asphyxia results in hypoxic and/or ischemic injuries to various organs of the newborn mainly kidneys, heart, lungs, liver and brain. Myocardial dysfunction is relatively common in asphyxiated neonates. Creatine Kinase MB had been the marker protein of choice for diagnosis of acute myocardial injury for many years. Recently, cardiac troponin I has been an area of interest in the assessment of the magnitude of myocardial injury in asphyxiated neonates. Aim of the work: This study aimed to compare serum Creatine Kinase MB (CK-MB) concentrations and cardiac troponin I(cTnI) concentrations among asphyxiated neonates in relation to other clinical and laboratory findings as useful markers of myocardial injury caused by perinatal asphyxia. Patients and Methods: This study included 40 asphyxiated neonates according to AAP & ACOG,(2006)and 20 healthy full term neonates as controls. Both asphyxiated and healthy neonates subjected to Umbilical cord blood gases, cardiac troponin I and CK-MB. During first 24 hrs was done, After 24 hrs CRP, serum electrolytes (Na, K, and Ca), renal and liver function tests. The results: The asphyxiated neonates had lower Apgar scores at 1,5,10 minutes than control neonates. Also asphyxiated neonates had moderate to severe metabolic or mixed acidosis, elevated both renal and liver function tests and hyperkalemia. Also they had thrombocytopenia, hyponatreamia and hypocalcaemia. These laboratory changes were severe in those who died than those who recovered. Asphyxiated neonates had significantly higher concentrations of cTnI and CK-MB than controls. There were a highly significant negative correlation between cTn I and Apgar scores in the asphyxiated groups at 1 min, 5 min and 10 min. There were a highly significant negative correlation between serum creatinine kinase and Apgar score at 5 min and 10 min. There were significant negative correlation between cTnI, and pH, PO2 and HCO3 in asphyxiated neonates. There were a significant positive correlation between cTnI and PaCO2. Also there was a highly significant negative correlation between CK.MB and both pH and HCO3. There were a significant negative correlation between cTnI and both hemoglobin & platelet count. Also, there were significant positive correlation between cTnI, CK-MB and WBCS count. There were a positive correlation between cTnI and CK.MB. Serum CK.MB had a significant positive correlation with serum creatinine. Serum cTnI concentrations were significantly higher in asphyxiated who died than those who survived. The serum cTnI had a sensitivity of 97% and specificity of 95%. While serum CK.MB had a sensitivity of 85% and specificity of 89% in prediction of perinatal asphyxia. Conclusion: CK MB was elevated in some healthy neonates, so it is not distinguish infants with and without asphyxia. Cardiac troponin I was more sensitive and specific than CK-MB in prediction of morbidity and mortality of perinatal asphyxia and can be used as a useful proxy marker for the anticipated severity of myocardial dysfunction.
Authors and Affiliations
Ahmed Thabet Mahmud
Keywords
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