Publication:

Evaluation of cardiac dysfunction in newborns with HIE with special reference to cardiac troponin I (hsTrop I)

Background Perinatal asphyxia is a major cause of neonatal and under 5 mortalities particularly in developing countries. Multiorgan dysfunction is common in newborns with perinatal asphyxia and cardiovascular involvement is associated with poor outcome.

Methods This prospective cohort study conducted at neonatal section of Jawaharlal Nehru Medical College and Hospital (JNMCH), AMU, Aligarh, included 126 newborns with hypoxic-ischemic encephalopathy (HIE) as case study group fulfilling inclusion criteria and 126 normal newborns as control group. All the newborns were then followed with high-sensitivity troponin I (hs-TropI) done in all newborns at 12 hours of life and echocardiography within 72 hours of life to evaluate cardiac function.

Results In our study cardiac dysfunction was present in 51.56% of newborn with HIE. Systolic dysfunction was present in only 9.4% case study group whereas diastolic dysfunction was present in 60 (46.9%) of case study group which was significantly higher than the control group (n=6;4.7%) (p value <0.001). In our study pulmonary arterial hypertension (PAH), mitral regurgitation (MR), tricuspid regurgitation (TR), and patent ductus arteriosus (PDA) were present in 38.3%, 2.3%, 46.1% and 4.7% in case study group. ROC curve analyses showed that a cut off value of hs-Trop I 64.8 ng/l can predict cardiac dysfunction in HIE newborn with sensitivity, specificity and accuracy of 78.89%, 58.06%, 68.75% respectively.

Conclusions Cardiac dysfunction was prevalent in children with HIE especially associated with diastolic dysfunction along with PAH. Cardiac dysfunction signifies poor outcome among HIE cases. Hs-Trop I showed positive association with cardiac dysfunction and can early predict the myocardial injury at 12 hours of life.