Sweetman Deirdre U, Kelly Lynne, Hurley Tim, Onwuneme Chike, Watson R William Gordon, Murphy John F A, Slevin Marie, Donoghue Veronica, Molloy Eleanor J
Department of Neonatology, National Maternity Hospital, Dublin, Ireland.
National Children's Research Centre, Dublin, Ireland.
Acta Paediatr. 2020 Nov;109(11):2266-2270. doi: 10.1111/apa.15255. Epub 2020 Apr 13.
Troponin is a sensitive marker of asphyxia in term infants mirroring the myocardial injury sustained in global hypoxia-ischaemia. In addition, troponin is a sensitive marker of severity of stroke in adults and neonatal encephalopathy (NE). We aimed to examine the relationship between troponin T in infants with perinatal asphyxia and brain injury on MRI and correlate with neurodevelopmental outcome.
Serum troponin was sampled in infants requiring resuscitation at birth and/or neonatal encephalopathy in a tertiary referral neonatal centre. Birth history, clinical parameters, neuroimaging and developmental outcome (Bayley Scores of Infant Development [BSID] III) were evaluated.
Infants with perinatal asphyxia (n = 54) had serum troponin T measured and 27 required therapeutic hypothermia. Troponin T levels on days 1 and 2 were predictive of need for TH, development of seizures and grade II/III NE (AUC = 0.7; P-values < .001), troponin T levels on days 1, 2 and 3 were highly significant predictors of mortality (AUC = 0.99, P-values .005). The cut-off values of troponin T for best prediction of mortality were 0.84, 0.63 and 0.58 ng/mL on days 1, 2 and 3, respectively. Troponin T on day 3 of life was predictive of injury in the combined area of basal ganglia/watershed on MRI (AUC 0.70; P-value = .045).
Infants with brain injury on neuroimaging following perinatal asphyxia had significantly elevated serum troponin, and troponin also correlated with developmental scores at 2 years. Further studies combining troponin and MRI may assist in the classification of neonatal brain injury to define aetiology, prognosis and response to treatment.
肌钙蛋白是足月儿窒息的敏感标志物，反映了在全脑缺氧缺血中所遭受的心肌损伤。此外，肌钙蛋白是成人中风和新生儿脑病（NE）严重程度的敏感标志物。我们旨在研究围产期窒息婴儿的肌钙蛋白T与MRI上脑损伤之间的关系，并与神经发育结局相关联。
在一家三级转诊新生儿中心，对出生时需要复苏和/或患有新生儿脑病的婴儿采集血清肌钙蛋白。评估出生史、临床参数、神经影像学和发育结局（贝利婴儿发育量表[BSID]III）。
对54例围产期窒息婴儿测定了血清肌钙蛋白T，其中27例需要治疗性低温。第1天和第2天的肌钙蛋白T水平可预测是否需要进行低温治疗、癫痫发作的发生以及II/III级NE（曲线下面积[AUC]=0.7；P值<0.001），第1天、第2天和第3天的肌钙蛋白T水平是死亡率的高度显著预测指标（AUC=0.99，P值=0.005）。第1天、第2天和第3天预测死亡率的肌钙蛋白T临界值分别为0.84、0.63和0.58 ng/mL。出生后第3天的肌钙蛋白T可预测MRI上基底节/分水岭联合区域的损伤（AUC 0.70；P值=0.045）。
围产期窒息后神经影像学显示有脑损伤的婴儿血清肌钙蛋白显著升高，且肌钙蛋白也与2岁时的发育评分相关。进一步结合肌钙蛋白和MRI的研究可能有助于新生儿脑损伤的分类，以明确病因、预后和治疗反应。
