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.

Cardiac Troponin T in Healthy Full-Term Infants

“…Cardiac troponin T (cTnT) has been reported to be elevated in healthy full-term infants [1, 2]. In the neonatal intensive care unit (NICU), cTnT is most commonly used to measure cardiac stress associated with asphyxia and patent ductus arteriosus [3–5].…”

“…Several studies have investigated cTnT values in infants after admission for neonatal care [3–5, 10–24]. Only a limited number of studies have determined cTnT values primarily in healthy full-term infants [1, 2, 25–28]. All but one of these studies have been performed before the introduction of hs-cTnT assays [2] and a considerable proportion of cTnT values were even below the detection limit [1, 25].…”

“…Only a limited number of studies have determined cTnT values primarily in healthy full-term infants [1, 2, 25–28]. All but one of these studies have been performed before the introduction of hs-cTnT assays [2] and a considerable proportion of cTnT values were even below the detection limit [1, 25]. Cardiac troponin T has in most cases been determined either in cord blood [1, 2, 25, 26, 28] or in peripheral blood [3, 11–13, 17–19, 21, 29].…”

“…All but one of these studies have been performed before the introduction of hs-cTnT assays [2] and a considerable proportion of cTnT values were even below the detection limit [1, 25]. Cardiac troponin T has in most cases been determined either in cord blood [1, 2, 25, 26, 28] or in peripheral blood [3, 11–13, 17–19, 21, 29]. Only a few studies have done sequential measurements of cTnT, and primarily in asphyxiated or premature infants [5, 10, 16].…”

COVID‐19 cardiac involvement in a 38‐day old infant

“…Cristina Baldoli MD 3 Antonio Esposito MD 4,5 Graziano Barera MD F I G U R E 2 A, Four chamber view of the heart taken during the first cardiological evaluation shows normal structure and dimensions of cardiac chambers, without pericardial effusion. B, Four chamber view of the heart four days after the previous one shows a 2 to 3 mm pericardial effusion in the lateral-posterior pericardial space (arrow)…”