Can a Single Value of Cardiac Troponin I Predict Short-term Adverse Outcomes in Premature Newborns?

Document Type : Original Article

Authors

1 Department of Pediatrics, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

3 Department of neonatology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran

4 Breastfeeding Research Center, Family Health Institute, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Cardiac troponin I (cTn I) has been demonstrated as a possible useful biomarker for myocardial injuries. The present study aimed to evaluate potential relationships between this biomarker and neonatal morbidities among preterm neonates.
Methods: This cohort study was carried out at an Iranian Hospital (Tehran-Iran; 2021). Newly-born preterm neonates entered the study. Blood sampling was performed immediately after neonatal intensive care unit (NICU)  admission and sent to the laboratory to detect levels of plasma cTnI. The correlations between the levels of plasma Tn I and each neonatal outcome were evaluated as the primary outcome.
Results: A total of 101  NICU hospitalized neonates with the mean gestational age, 1st, and 5th minutes Apgar scores of 33.750±2.125 (Range: 29-37) weeks, 7.6471±1.766, and 9.188±1.205 entered the study. The mean and median of Troponin I levels were 0.131±0.126 and 0.0920 ng/ml. The results pointed out that neonates who died during hospitalization or required CPR (cardiopulmonary resuscitation) had lower troponin I in comparison with their controls; nonetheless, the differences were not significant (P=0.950 & P=0.557). The mean±SD of troponin I was not significantly different between neonates with and without PDA (p=0.741), asphyxia (P=0.298), and intubation (P=0.212). The occurrences of necrotizing enterocolitis, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis were not also significant factors for the alteration of troponin I (P>0.05).
Conclusion: Since there were no relationships between cTn I and neonatal outcomes, great caution should be implemented regarding the use of single cTn I value as a diagnostic marker for short-term neonatal adverse outcomes. Further investigations with larger sample sizes are strongly suggested.
 
 

Keywords


  1. Crilly CJ, Haneuse S, Litt JS. Predicting the outcomes of preterm neonates beyond the neonatal intensive care unit: What are we missing? Pediatric Research. 2021;89(3):426-45.
  2. Wang L-W, Lin Y-C, Wang S-T, Huang C-C, Tsou K-I, Tsao P-N, et al. Trendsin survival, neonatal morbidity and neurodevelopmental outcome of very preterm infants in Tainan, Southern Taiwan, 1995–2016. Journal of the Formosan Medical Association. 2021;120(6):1314-23.
  3. Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S, editors. Risk factors for neonatal morbidity and mortality among "healthy," late preterm newborns. Seminars in perinatology; 2006: Elsevier.
  4. Hanna M, Brophy PD, Giannone PJ, Joshi MS, Bauer JA, RamachandraRao S. Early urinary biomarkers of acute kidney injury in preterm infants. Pediatric research. 2016;80(2):218-23.
  5. Gilfillan M, Bhandari V. Neonatal sepsis biomarkers: where are we now? Research and Reports in Neonatology. 2019;9:9-20.
  6. Ng PC, editor An update on biomarkers of necrotizing enterocolitis. Seminars in Fetal and Neonatal Medicine; 2018: Elsevier.
  7. Usluer H, Turker G, Gokalp AS. Value of homocysteine levels, troponin I, and score for neonatal acute physiology and perinatal extension
    II as early predictors of morbidity. Pediatrics International. 2012;54(1):104-10.
  8. 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. Journal of International Medical Research. 2019;4. 3234-42:(7)7
  9. Tanasan A, Eghbalian F, Sabzehei MK, Rastgoo Haghi A. The relationship between serum levels of troponin I and myocardial function in neonates under mechanical ventilation. Iranian Journal of Pediatrics. 2020;30(1).
  10. Shastri AT, Samarasekara S, Muniraman H, Clarke P. Cardiac troponin I concentrations in neonates with hypoxic‐ischaemic encephalopathy. Acta Paediatrica. 2012;101(1):26-9.
  11. Mahmoud AT, El-Bassuny M, Shebl A. Cardiac troponin I as an early predictor of perinatal asphyxia. Menoufia Medical Journal. 2013;26(2):145.
  12. Bader D, Kugelman A, Lanir A, Tamir A, Mula E, Riskin A. Cardiac troponin I serum concentrations in newborns: A study and review of the literature. Clinica Chimica Acta. 2006;371(1):61-5.
  13. Mu SC, Wang LJ, Chen YL, Lin MI, Sung TC. Correlation of troponin I with perinatal and neonatal outcomes
    in neonates with respiratory distress. Pediatrics International. 2009;51(4):548-51.
  14. McAuliffe F, Mears K, Fleming S, Grimes H, Morrison JJ. Fetal cardiac troponinI in relation to intrapartum events and umbilical artery pH. American journal of perinatology. 2004;21(03):147-52.
  15. Tarkowska A, Furmaga-Jabłońska W. The Evaluation of Cardiac Troponin T in Newborns. Biomedicine hub. 2017;2(3):1-7.
  16. Mayasari NMC. Correlation between Troponin-I and Lowering Cardiac Function in Newborn with Respiratory Distress. EC Paediatrics. 2019;8:192-201.
  17. Quivers ES, Murthy JN, Soldin SJ. The effect of gestational age, birth weight, and disease on troponin I and creatine kinase MB in the first year of life. Clinical biochemistry. 1999;32(6):419-21.
  18. König K, Guy KJ, Nold-Petry CA, Barfield CP, Walsh G, Drew SM, et al. BNP, troponin I, and YKL-40 as screening markers in extremely preterm infants at risk for pulmonary hypertension associated with bronchopulmonary dysplasia. American Journal of Physiology-Lung Cellular and Molecular Physiology. 2016;311(6):L1076-L81.
  19. Distefano G, Sciacca P, Mattia C, Betta P, Falsaperla
    R, Romeo M, et al. Troponin I as a biomarker of cardiac injury in neonates with idiopathic respiratory distress. American journal of perinatology. 2006;23(04):229-32.
  20. Simovic AM, Stojkovic AK, Dejan JM, Savic D. Is it Possible to Predict Mortality in Preterm Neonates, Based on a Single Troponin I Value at 24 h? Indian journal of pediatrics. 2016;83(5):466-7.
  21. El-Khuffash AF, Slevin M, McNamara PJ, Molloy EJ. Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infants. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2011;96(2):F133-F7.