How To Interpret Elevated Plasmatic Level of High-Sensitive Troponin T in Newborns and Infants?

Abstract

Research and clinical implications on novel cardiac biomarkers has intensified significantly in the past few years. The high-sensitive troponin T (hscTnT) assay plays a dominant role in diagnostic algorithm regarding myocardial injury in adults. Despite generally accepted use of hscTnT there are no data about physiological concentrations and cut-off limits in neonates and infants to date. The aim of this study is to assess hscTnT levels in healthy newborns and infants. Consecutively 454 healthy full termed newborns and 40 healthy infants were enrolled in the study. Samples of cord or venous blood were drawn and tested for hscTnT concentrations with high-sensitive TnT assay (Roche Cobas e602 immunochemical analyzer). The 97.5 percentile of hscTnT concentration was assessed and correlation analysis was performed in neonates. Two hundred and thirteen samples (47 %) were excluded due to blood hemolysis of various degrees in neonates. Finally, the group of 241 healthy newborns was statistically analyzed. The median concentration of hscTnT was 38.2 ng/ml, 97.5 percentile reached 83.0 ng/l (confidential interval 74.1 to 106.9 ng/l). HscTnT concentrations were statistically decreased in hemolytic samples when compared to non-hemolytic samples (34.3 ng/l [26.7 to 42.0 ng/l] and 37.1 ng/l [30.5 to 47.9 ng/l], respectively, p=0.003). Elevated plasma concentrations of hscTnT decreased to adult level within six months. This study has confirmed the higher reference levels of hscTnT in neonates and young infants when compared with adult population. Many extracardiac factors as hemolysis and age may affect the hscTnT level. Based on presented results, a careful clinical interpretation of hscTnT is recommended.

Associations of High-Sensitive Cardiac Troponin T in Healthy Newborns and Prolonged Second Stage of Labor, Neonatal and Maternal Factors: A Prospective Study

“…Virtually, all the hs-cTnT values obtained in the present study are considered abnormal in adults based on the latest European guidelines for the reference values, with a cutoff value of >14 ng/L (>99th percentile) [6]. We found that the median hs-cTnT was 39.03 (25th–75th percentiles = 30.53–54.09) ng/L, which is consistent with previous reports [11, 12]. Nevertheless, there are no guidelines related to interpreting troponin values in newborns.…”

“…Previous studies reported that cord blood hs-cTnT values were significantly higher in male infants than females [11, 12, 15], which is inconsistent with our result that there were no significant differences between male and female newborns, in the levels of hs-cTnT and with other studies [7, 14, 16, 17, 23, 24]. No significant correlations were found between hs-cTnT and tested laboratory variables including CRP, CK, lactate, pH, pCo 2 , HCO 3, and O 2 saturation.…”

“…The high precision of hs-cTnT assays (increased ability to determine small differences in cTnT over time and to detect troponin T elevation in blood within 2 h and with higher sensitivity after a myocardial insult) made it the assay of choice. However, few studies have addressed hs-cTnT levels in healthy full-term infants [11, 12]. Hs-cTnT values are usually measured in cord blood [2, 15, 16, 18, 21, 22] or in peripheral blood [4, 6, 23, 24].…”

Cardiac Troponin-T Release After Sport and Differences by Age, Sex, Training Type, Volume, and Intensity: A Critical Review

“…The limited data available on hs-cTnI and hs-TnT circulating levels in pediatric age suggest that biomarker values are greatly increased in the neonates with a successive trend to progressively reduction up to adolescence. 67,82-85 However, hs-cTnI and hs-cTnT values in apparently healthy boys and girls on average tend to remain significantly higher than those measured in adults. 67,82-85…”

“…67,82-85 However, hs-cTnI and hs-cTnT values in apparently healthy boys and girls on average tend to remain significantly higher than those measured in adults. 67,82-85…”