Concentrations of cardiac troponin T in neonates with and without respiratory distress

Abstract

Aims: To establish a practical postnatal reference range for cardiac troponin T in neonates and to investigate concentrations in neonates with respiratory distress. Methods: Prospective investigation in a tertiary neonatal unit, recruiting infants with and without respiratory distress (sick and healthy infants respectively). Concentrations of cardiac troponin T were compared between sick and healthy infants, accounting for confounding variables. Results: A total of 162 neonates (113 healthy and 49 sick infants) had samples taken. The median (interquartile range) cardiac troponin T concentration in the healthy infants was 0.025 (0.01-0.062) ng/ ml, and the 95th centile was 0.153 ng/ml. There were no significant relations between cardiac troponin T and various variables. The median (interquartile range) cardiac troponin T concentration in the sick infants was 0.159 (0.075-0.308) ng/ml. This was significantly higher (p , 0.0001) than in the healthy infants. In a linear regression model, the use of inotropes and oxygen requirement were significant associations independent of other basic and clinical variables in explaining the variation in cardiac troponin T concentrations. Conclusions: Cardiac troponin T is detectable in the blood of many healthy neonates, but no relation with important basic and clinical variables was found. Sick infants have significantly higher concentrations than healthy infants. The variations in cardiac troponin T concentration were significantly associated with oxygen requirement or the use of inotropic support in a regression model. Cardiac troponin T may be a useful marker of neonatal and cardiorespiratory morbidity.

Cardiac troponin T and N-terminal-pro-B type natriuretic peptide reflect myocardial function in preterm infants

“…cTnT and NTpBNP were unaffected by gestation, birth weight, sex, chorioamnionitis and mode of delivery. This is consistent with the results of other groups [17][18][19][20] and suggests that assays of cTnT and Abbreviations: cTnT, cardiac troponin T; FS, shortening fraction; LA:Ao ratio, left atrial to aortic root ratio; Min-Max, minimum to maximum value; mVcfs, mean circumferential fiber shortening velocity; NTpBNP, N-terminal-pro-B type natriuretic peptide; PDA, patent ductus arteriosus. …”

“…1 Infants requiring inotropes had higher cTnT compared to those who were normotensive but this did not reach statistical significance possibly due to the relatively small number of subjects. Clark SJ et al 18,22 showed a similar effect of inotropes on cTnT levels. Whether the rise in cTnT in hypotensive infants is a direct result of the inotropes or cardiovascular compromise occurring before delivery is unclear.…”

Should We Consider Bilirubin When Dosing Troponin in Newborns? Case Report

“…Since troponins do not occur in extracellular space, their appearance in serum is sensitive and specific marker of myocardium damage [2].They start to increase two hours after myocardial infarction or damage, and concentrations can remain raised for up to two weeks after a full thickness infarct [1]. Troponin rising has been described also in other clinical conditions with possible myocardial damage, such as, myocarditis [3], trauma [4], etc: every cardiac troponin value above the 99th percentile of the reference population in the typical clinical setting may be interpreted as myocardial damage with an increase in the risk of major cardiac events [5].…”

“…Cardiac troponin is a highly specific and very sensitive marker of myocardial necrosis recently used in newborns to rule out a myocardial ischaemia [1]. We report a case of an apparently healthy (except for jaundice) term newborn in which high values of troponin were not related to a documentable myocardial injury.…”

Use of cardiac biomarkers in neonatology

“…Clark et al found that the cTnT levels were significantly higher in sick infants than in healthy ones. The use of inotropic support and oxygen requirement were independently associated with higher cTnT levels (79).…”