Correlation of cardiac troponin T levels with inotrope requirement, hypoxic-ischemic encephalopathy, and survival in asphyxiated neonates

BACKGROUND: Cardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality. AIM: To assess cardiac troponin T (cTnT) levels in asphyxiated neonates and their correlation with echocardiography findings, inotrope requirement, hypoxic-ischemic encephalopathy (HIE) stages, and mortality. METHODS: cTnT levels, echocardiographic findings, the requirement of inotropes, HIE stages, and outcome were studied in neonates of gestational age ≥ 34 wk with perinatal asphyxia. RESULTS: Among 57 neonates with perinatal asphyxia, male gender, cesarean section, forceps/vacuum-assisted vaginal delivery and late preterm included 33 (57.9%), 23 (40.4%), 3 (5.3%), and 12 (21.1%) respectively. The mean gestational age was 38.4 wk (1.6 wk). HIE stages I, II, and III were observed in 7 (12.3%), 37 (64.9%), and 9 (15.8%) neonates respectively. 26 (45.6%) neonates had echocardiographic changes and 19 (33.3%) required inotropes. cTnT levels were elevated in 41 (71.9%) neonates [median (IQR); 0.285 (0.211-0.422) ng/mL]. The Median cTnT level showed an increasing trend with increasing changes in echocardiography (P = 0.002). Two neonates with mitral regurgitation and global hypokinesia had the highest cTnT levels (1.99 and 0.651 ng/mL). Of 31 neonates with normal echocardiography, 18 (58.06%) showed elevated cTnT. cTnT levels were significantly higher in those who required inotropic support than those who did not (P = 0.007). Neonates with HIE stage III had significantly higher cTnT levels compared to those with HIE stage I/II (P = 0.013). Survivors had lower median cTnT levels [0.210 (0.122-0.316) ng/mL] than who succumbed [0.597 (0.356-1.146) ng/mL]. CONCLUSION: cTnT levels suggestive of cardiac involvement were observed in 71.9% of asphyxiated neonates. cTnT levels correlated with echocardiography findings, inotrope requirement, HIE stages, and mortality.