CARDIOVASCULAR EVALUATION OF NEONATES WITH PERINATAL ASPHYXIA WITH SPECIAL REFERENCE TO CARDIAC TROPONIN T LEVELS ,CREATINE KINASE MB AND 2D ECHO.

Abstract

Methods:70 term babies with perinatal asphyxia were selected as cases.They were evaluated
within 24 hours of birth using echocardiography and cardiac enzymes i.e. Troponin T and
CK-MB levels .
Results:Incidence of cardiac dysfunction in neonates was reported and correlated with
cardiac enzymes.Majority had moderate HIE (51.4%), a total of 23 (32.9%) had mild HIE
and 11 (15.7%) had severe HIE.Echo findings were abnormal in 45 / 70 (64.3%) of neonates
with Tricuspid regurgitation being most common seen in 16/45 ( 35.6 %).A total of 59
(84.3%) cases had Cardiac Troponin T levels >0.1 ng/ml.There were 17 (24.3%) neonates
with CK-MB levels <46.5 U/L and 15 (21.4%) with CK-MB levels >110 U/L respectively.A
total of 58 (82.9%) neonates survived. Mortality rate was 17.1%.Presence of meconium
stained liquor, antenatal complications and moderate to severe HIE were found to be
significantly associated with increased risk of abnormal echo.Mean cardiac Troponin T levels
and CK-MB levels were significantly higher in abnormal echo group as compared to those
having normal echo (p<0.001).Cardiac Troponin T had a better efficacy in view of its higher
specificity (88%) as compared to CK-MB (76%) at same sensitivity (84.4%).For the outcome
of neonatal death echocardiography had higher sensitivity (100%) as compared to Cardiac
Troponin T (91.7%) and CK-MB (91.7%). However, both the cardiac enzymes had higher
specificity (94.8% and 85.5% for C-Tn-T and CK-MB respectively) as compared to
echocardiographic evaluation (43.1%).
Conclusion:Echocardiography and cardiac enzymes i.e. cardiac troponin T levels and CK-
MB levels correlates well with severity and outcome in perinatal asphyxia.