Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: is it a significant predictor of mortality?

Kanık, Esra Toprak; Özer, Esra Arun; Bakiler, Ali Rahmi; Aydınlıoğlu, Halil; Dorak, C; Dogrusoz, Buket; Kanık, Ali; Yaprak, Işın

doi:10.1080/14767050802430834

Cited by 53 publications

(55 citation statements)

References 19 publications

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“…11 There was a linear relation between the severity of asphyxia as assessed by HIE grading and the CK-MB values. The Percentage of babies with grade three HIE was similar to Rajkumar PS et al, Karnik E et al whereas HIE grade 3 was higher in Jyoti et al 10,12,13 In present study, there was no significant difference in CK-MB values between HIE 1 and 2, whereas between HIE 1 and 3 the rise was statistically significant showing that evaluation of enzymes can be a good tool to assess the severity of HIE. In a study conducted by Merchant S et al also there was a significant difference between HIE1 and 3 ( Table 8).…”

Section: Asphyxia and Hiesupporting

confidence: 46%

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A biochemical profile of cardiac involvement in perinatal asphyxia

Kumar¹,

Arasan²

2018

Int J Contemp Pediatr

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Background: Perinatal hypoxia is one of the leading causes of mortality and morbidity in developing countries like India, and even in developed countries. Perinatal hypoxia can result in Transient myocardial ischemia, tricuspid and mitral regurgitation, myocardial infarction, cardiac failure. The measurement of Creatine kinase -MB isoenzyme a cardiac specific enzyme helps in assessing the degree of myocardial involvement in asphyxiated infants.Methods: A Prospective case-control study was done in a Tertiary care centre serving rural areas predominantly, to determine the cardiac involvement by measuring serum MB isoenzyme of creatine kinase in perinatally asphyxiated inborn term babies for a period of six months.Results: There was a significant difference in the CK-MB values with regard to weight in both cases and controls. The mean CK-MB levels were higher in babies who had assisted delivery (forceps and breech) than those delivered by labour natural and LSCS. Mean CK-MB values of asphyxiated and controls were 133.8u/l and 27.12 u/l respectively with a p value of < 0.01. There was a significant difference between HIE1 and 3 with a p value of<0.02. Out of 60 cases 28 had abnormal ECG findings (46.6%). Statistically significant difference was found in the mean CK-MB between the normal and Grade4 ECG changes group. The overall predictive accuracy of CK-MB is high in Perinatal asphyxia (88%), Cardiac involvement (83%), Mortality (83%) and a moderate predictive accuracy for HIE (75%).Conclusions: Cardiac abnormalities in asphyxiated neonates are often underdiagnosed and requires high index of suspicion. Cardiac specific enzyme CK-MB helps in early recognition of myocardial damage and better management of cases, would reduce the neonatal mortality and morbidity. An expectant eye can be kept for complications in babies with markedly elevated CK-MB enzyme.

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Section: Asphyxia and Hiesupporting

confidence: 46%

“…10,12,13 This may be due to great variation in Twave changes in normal babies in the first week of life. The ECG changes observed in asphyxiated babies is similar to those observed in Rajkumar PS et al, except that in their study, Grade 2 changes were more.…”

Section: Ecg Changesmentioning

confidence: 99%

A biochemical profile of cardiac involvement in perinatal asphyxia

Kumar¹,

Arasan²

2018

Int J Contemp Pediatr

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“…One of the organs significantly involved in the fate of the asphyctic newborn is the heart (3,4); it can compromise the oxygen supply of other organs, resulting in irreversible injury (5). It is therefore important to maintain adequate cardiac function in neonates who have undergone an asphyxic insult.…”

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confidence: 99%

Propofol administration to the fetal–maternal unit reduces cardiac injury in late-preterm lambs subjected to severe prenatal asphyxia and cardiac arrest

et al. 2013

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Background: cardiac dysfunction is reported to occur after severe perinatal asphyxia. We hypothesized that anesthesia of the mother with propofol during emergency cesarean section (c-section) would result in less cardiac injury (troponin T) in preterm fetuses exposed to global severe asphyxia in utero than anesthesia with isoflurane. We tested whether propofol decreases the activity of proapoptotic caspase-3 by activating the antiapoptotic AKT kinase family and the signal transducer and activator of transcription-3 (sTAT-3). Methods: Pregnant ewes were randomized to receive either propofol or isoflurane anesthesia. A total of 44 late-preterm lambs were subjected to in utero umbilical cord occlusion (UcO), resulting in asphyxia and cardiac arrest, or sham treatment. After emergency c-section, each fetus was resuscitated, mechanically ventilated, and supported under anesthesia for 8 h using the same anesthetic as the one received by its mother. results: At 8 h after UcO, the fetuses whose mothers had received propofol anesthesia had lower plasma troponin T levels, and showed a trend toward a higher median left ventricular ejection fraction (LVeF) of 84% as compared with 74% for those whose mothers had received isoflurane. Postasphyxia activation of caspase-3 was lower in association with propofol anesthesia than with isoflurane. Postasphyxia levels of sTAT-3 and the AKT kinase family rose 655% and 500%, respectively with the use of propofol anesthesia for the mother. conclusion: The use of propofol for maternal anesthesia results in less cardiac injury in late-preterm lambs subjected to asphyxia than the use of isoflurane anesthesia. The underlying mechanism may be activation of the antiapoptotic sTAT-3 and AKT pathways. Multi-organ dysfunction is a common outcome of severe perinatal asphyxia (1,2). One of the organs significantly involved in the fate of the asphyctic newborn is the heart (3,4); it can compromise the oxygen supply of other organs, resulting in irreversible injury (5). It is therefore important to maintain adequate cardiac function in neonates who have undergone an asphyxic insult. Currently, the only available therapy for cardiac function in the neonatal setting after an ischemic insult consists in treatment with positive inotropic and/or vasoactive drugs. The impact of this measure is limited because it neither prevents nor attenuates the degree of the initial myocardial ischemic injury (6,7). Evidence has now accumulated that some anesthetics such as propofol are cardioprotective in adult patients exposed to myocardial ischemia (8)(9)(10), and that this propofol-related cardioprotection is mediated through the activation of signal transducer and activator of transcription (STAT)-3 and phosphoinositide-3-kinase/AKT (11). Isoflurane, a volatile anesthetic, also protects the adult heart from ischemia and reperfusion injury by intervening with the mitochondrial apoptosis pathway (12,13). Both anesthetics are rapid acting and reliable and are therefore used when prompt delivery of the fetus becomes e...

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“…Organ sistemlerinin erken dönemdeki etkilenmesi, klinik izlem ve monitörizasyon ile tespit edilmekle birlikte etkilenmenin laboratuvar olarak tanımlanması ancak ölçülebilen değişkenler ile mümkün olabilmektedir. Bu konuda yapılan çalışmalarda HİE'li olgularda serum CK-MB, AST ve ALT düzeylerinde artış olduğu bildirilmiştir (8)(9)(10)18). Çalışma-mızda CK-MB'deki artış ile olguların mortalitesi arasında kuvvetli bir ilişki saptandı; ancak AST ve ALT düzeyleri ile mortalite arasında ilişki saptanmadı.…”

Section: Discussionunclassified

The Evaluation Of The Association Of Laboratory Tests Associated With Mortality In Term Neonates With Hypoxic-ischemic Encephalopathy

Can¹,

Bülbül²,

Nuhoğlu³

2010

TUTFD

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ÖZETAmaç: Hipoksik iskemik ensefalopati (HİE) tanılı zamanında doğan yenidoğan bebeklerin erken dönem laboratuvar testlerinin mortalite ile ilişkisinin değerlendirilmesi. Gereç ve Yöntemler: Ocak 2004-Aralık 2008 tarihleri arasında HİE tanısı alan yenidoğan bebekler; yaşayan ve ölen olarak iki gruba ayırılarak prospektif olarak incelendi.Bulgular: Çalışmaya 32 yenidoğan alındı. Sarnat&Sarnat'a göre bebeklerin 9'u (%28.1) evre 1, 14'ü (%43.8) evre 2 ve 9'u (%28.1) evre 3 idi. Bebeklerin 8'i (%25) kaybedildi. Risk faktörlerinin korelasyon değerlendirme-sinde; antenatal takipsizlik (r²=0.35) ve konvülsiyon geçirmenin (r²=0.50) Sarnat evresi ile, Sarnat evresinin de mortalite ile pozitif ilişkili olduğu saptandı (r²=0.57). Laboratuvar testlerinde CK-MB ölüm oranı ile kuvvetli ilişkili (r²=0.74), troponin-I orta düzeyde ilişkili (r²=0.44), pH ise zayıf ilişkili bulundu (r²=0.27). Mortalite için CK-MB ve Troponin-I seviyelerinin prediktivitesinin yüksek, pH'nın ise orta dereceli olduğu saptandı. CK-MB'nin mortalite için duyarlılığı %100, özgüllüğü %91.6; Troponin-I'nın mortalite için duyarlılığı %100 ve özgüllüğü %70.8; pH'nın mortalite için duyarlılığı %75 ve özgüllüğü %87.5 bulundu.Sonuç: HİE tanılı zamanında doğmuş yenidoğan bebeklerde, erken dö-nem ölüm oranlarının, CK-MB değeri ile yüksek, Troponin-I değeri ile orta ve pH değeri ile zayıf ilişkili olduğu saptandı.Anahtar Sözcükler: Hipoksik-iskemik ensefalopati, mortalite, CK-MB, troponin-I, yenidoğan The evaluation of the relationships between the mortality and early period laboratory tests in the term infants diagnosed as hypoxic ischemic encephalopathy (HIE). Material and Methods:The newborns diagnosed as HIE between January 2004 and December 2008 were divided into two groups as the living and non-surviving groups. The two groups were evaluated prospectively.Results: Thirty two infants were included in the study. According to the Sarnat&Sarnat classification, 9 (28.1%), 14 (43.8%) and 9 infants (28.1%) were in stage 1, 2 and 3, respectively. Eight (25%) infants died. In the correlation evaluation of risk factors; lack of-follow-up at the antenatal period (r²=0.35) and having convulsions (r²=0.50) were positively associated with Sarnat stage. A positive relationship between Sarnat stage and the mortality rate was also determined (r²=0.57). CK-MB was strongly (r²=0.74), troponin-I moderately (r²=0.44), and pH weakly (r²=0.27) associated with mortality. In predicting mortality, the sensitivity and specificity for CK-MB was 100% and 91.6%, for Troponin I 100% and 70.8% and for pH 75% and 87.5%, respectively. Conclusion:This study demonstrates that in HIE, the relationship between the early period mortality rate and CK-MB values are strong, whereas for troponin-I and pH there is a moderate and weak association respectively.Key Words: Hypoxic-ischemic encephalopathy, mortality, CK-MB, troponin I, newborn : 28.01.2010: 28.01. Accepted: 07.05.2010 Giriş Hipoksik iskemik ensefalopati (HİE) intrapartum hipoksi veya geç antepartum serebral hipoksi ve iskeminin neden ol...

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Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: is it a significant predictor of mortality?

Cited by 53 publications

References 19 publications

A biochemical profile of cardiac involvement in perinatal asphyxia

A biochemical profile of cardiac involvement in perinatal asphyxia

Propofol administration to the fetal–maternal unit reduces cardiac injury in late-preterm lambs subjected to severe prenatal asphyxia and cardiac arrest

The Evaluation Of The Association Of Laboratory Tests Associated With Mortality In Term Neonates With Hypoxic-ischemic Encephalopathy

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