| Abstract: |
Background: Perinatal asphyxia is a well-recognized clinical entity that confronts obstetricians and neonatologists almost daily. from the clinical and prognostic point of view, neurological dysfunction arising from hypoxic-ischemic encephalopathy represents a major topic. The outcome of HIE depends on the severity of hypoxia but is usually grim. HIE is one of leading causes of death and permanent disability in pediatric intensive care unit. Recently, cardiac Troponin I (cTnI) has been an area of interest. Troponin is an inhibitory protein complex located on the actin filament in all striated muscle, and consists of three subunits; T, C and I. Cardiac troponin I was measured as an indicator of cardiac injury for long time, but it has been in interest for the prediction of poor neonatal outcome in perinatal asphyxia.Objectives: The present work aims to test the cardiac Troponin I (cTnI) a known marker of myocardial injury is an early predictor of severity of cerebral damage and mortality in perinatal asphyxia.Patients and methods: This study was performed on neonates admitted to the neonatal intensive care unit of Pediatric Department in Zagazig University Hospitals and included 40 cases with perinatal asphyxia and 20 healthy normal outpatient neonates were taken as a control group. All cases were subjected to meticulous history taking and complete through clinical examination, relevant data obtained by history, clinical examination was done as regards gestational age, birth weight, sex, mode of delivery, risk factors, Apgar scores, neonatal resuscitation and assessment of grades of HIE. Laboratory investigations include CBC, CRP, serum electrolytes, blood glucose level, kidney function tests, ABG, cTnI and CKMB, MRI were measured in both the studied cases and control group. MRI was done to the asphyxiated cases. All data were tabulated and processed by usual statistical program. The following findings were obtained: Regarding clinical signs, the asphyxiated neonates showed variable signs of cardiac affections (tachycardia and bradycardia), murmurs, tenderness, respiratory signs (tachypnea, lung eruptions and cyanosis) and neurological signs (poor reflexes, abnormal tones, depressed consciousness and convulsions) which were significantly higher in asphyxiated neonates than in normal control. In echocardiographic examination, there was a statistical significant difference between asphyxiated neonates and control group as regards cardiomegaly, poor contractility, tricuspid incompetence, decreased fractional shortening, decreased ejection fraction and decreased E/A ratio. Routine laboratory tests showed that RBC count and platelet count was significantly lower and WBC count was significantly higher in patient group than in control group. Serum sodium and blood glucose levels were significantly lower in asphyxiated neonates compared to control group..
|
|
|