Daño miocárdico secundario a asfixia neonatal grave

Abstract

Myocardial damage following neonatal asphyxiaSixteen newborn infants with severe asphyxia were prospectively studied for evidence of secondary myocardial damage and, in that case, their clinical findings. Myocardial damage was diagnosed in three term newborn infants of adequate weight for gestacional age (18,7%) by means of serial electrocardiograms taken in the first 72 hours of life. Two of them showed evidence of difusse subendocard'al ischemia and a third one showed electrocardiographic signs suggesting necrosis of the left ventricular posteroinferior wall. Neither creatinephosphokinase serum activity nor its muscle brain MB isoenzyme were useful in the identification of myocardial damage. All three affected neonates developed respiratory distress syndrome without signs of cardiac failure and one of them died. The histopathological study of this late one showed localized hemorrhage of the papillary muscles and interventricular septum. These finding underscore the need of serial electrocardiographic recordings in newborns with severe asphyxia, sincecardiac dysfunction may inadvertently occur under the appearence of respiratory distress syndrome. (Key words: myocardium, ischemia,asphyxia neonatorum.)La relacion entre asfixia neonatal grave y disfuncion miocardica fue descrita en 1961 l y ampliada posteriormente con tres recien nacidos de termino con insuficiencia cardiaca congestiva y falla ventricular izquierda, que no eran portadores de enfermedad cardiaca congenita 2 . La asfixia neonatal grave puede determinar grados variables de disfuncion miocardica, manifestandose como isquemia transitoria del musculo cardiaco que puede terminar en infarto; insuficiencia tricuspi'dea; insuficiencia cardiaca congestiva; edema agudo pulmonar y cheque cardiogenico 1 ' 8 . Estas manifestaciones, inicialmente, pueden pasar inadvertidas o confundirse con un sindrome de dificultad respiratoria 2 ' 3 . For este motivo es importante reconocer precozmente el dafio miocardico secundario a asfixia perinatal, a fin de instaurar las medidas que permitan una mejoria mas rapida del recien nacido y su pronostico. El objetivo del presente estudio fue buscar y describir evidencia clinica y de labo-