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

Himanshu Saraswat; Syed M. Ali; Uzma Firdaus; Shaad Abqari

doi:10.18203/2349-3291.ijcp20263294

Authors

Himanshu Saraswat Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
Syed M. Ali Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
Uzma Firdaus Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India
Shaad Abqari Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263294

Keywords:

HIE, HsTrop I, Cardiac dysfunction, PAH

Abstract

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.

References

Agarwal R, Jain A, Deorari AK, Paul VK. Post-resuscitation management of asphyxiated neonates. Indian J Pediatr. 2008;75:175-80.

Pauliah SS, Shankaran S, Wade A, Cady EB, Thayyil S. Therapeutic hypothermia for neonatal encephalopathy in low- and middle-income countries: a systematic review and meta-analysis. PLoS One. 2013;8(3):e58834.

Investigators of the National Neonatal Perinatal Database (NNPD), National Neonatology Forum of India. Morbidity and mortality among outborn neonates at 10 tertiary care institutions in India during the year 2000. J Trop Pediatr. 2004;50(3):170-4.

UNICEF. Newborn and child health: Let’s end preventable neonatal death and ensure every child alive. Available from: https://www.unicef.org/ india/what-we-do/newborn-and-child-health. Accessed on 15 July 2026.

Dubie AG, Kokeb M, Mersha AT, Agegnehu CD. Prevalence and associated factors of perinatal asphyxia in newborns admitted to neonatal intensive care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. BMC Pediatr. 2021;21:1-8.

Perlman JM, Tack ED, Martin T, Shackelford G, Amon E. Acute systemic organ injury in term infants after asphyxia. Am J Dis Child. 1989;143(5):617-20.

Jiang L, Li Y, Zhang Z, Lin L, Liu X. Use of high-sensitivity cardiac troponin I levels for early diagnosis of myocardial injury after neonatal asphyxia. J Int Med Res. 2019;47(7):3234-42.

Cameron WS, Merhar T. Hypoxic-ischemic encephalopathy. In: Nelson Textbook of Pediatrics. 22nd ed. India: Elsevier. 2020;918-23.

Ranjit MS. Cardiac abnormalities in birth asphyxia. Indian J Pediatr. 2000;67:529-32.

Jiang L, Li Y, Zhang Z, Lin L, Liu X. Use of high-sensitivity cardiac troponin I levels for early diagnosis of myocardial injury after neonatal asphyxia. J Int Med Res. 2019;47(7):3234-42.

Issa A, Abdulkadir MB, Ibraheem RM, Ibrahim OR, Bello SO, Suberu H, et al. Relationships between troponin I and hypoxic–ischemic encephalopathy among newborn babies. J Clin Neonatol. 2021;10(3):187-91.

Shastri AT, Samarasekara S, Muniraman H, Clarke P. Cardiac troponin I concentrations in neonates with hypoxic-ischaemic encephalopathy. Acta Paediatr. 2012;101(1):26-9.

Tissot C, Singh Y, Sekarski N. Echocardiographic evaluation of ventricular function-for the neonatologist and pediatric intensivist. Front Pediatr. 2018;6:79.

Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314.

Singh V, Vohra R, Bansal M. Cardiovascular involvement in birth asphyxia. J Clin Neonatol. 2018;7(1):20-4.

Armstrong K, Franklin O, Sweetman D, Molloy EJ. Cardiovascular dysfunction in infants with neonatal encephalopathy. Arch Dis Child. 2012;97(4):372-5.

Mathur D, Gupta PK, Punj A. Role of 2D echo in neonates with perinatal asphyxia and its correlation with cardiac troponin T levels and creatine kinase MB. Age (Hours). 2017;24(21):70-80.

Jain D, Pandey AK, Das BK, Prasad R. Cardiac function in perinatal asphyxia. Sch J Appl Med Sci. 2016;4(7F):2718-28.

Lee IC, Yu CS, Wong SH, Lue KH. Troponin I levels in neonatal hypoxic–ischemic encephalopathy are related to cardiopulmonary comorbidity and neurodevelopmental outcomes. J Clin Med. 2021;10(17):4010.

Zainab, Ali SM, Afzal K. Incidence and outcomes of acute kidney injury in term neonates with hypoxic ischemic encephalopathy: an observational study. Int J Contemp Pediatr. 2022;9:589-94.