Cardiac Function in Perinatal Asphyxia

At present no clear-cut physiologic/serological parameter exist which enable an early identification of neonates who are at increased risk to develop myocardial dysfunction in perinatal asphyxia. This study was conducted to find out the incidence and features of cardiac dysfunction in perinatal asphyxia The present study was carried out on 48 neonates ,17 healthy neonates were taken as controls while 31 neonates with perinatal asphyxia enrolled within 72 hours of birth as cases. Electrocardiographic, echocardiographic and biochemical parameters were obtained in all subjects and were correlated with the severity of disease and its outcome. Mean CK-MB level in neonates with perinatal asphyxia was 15.18 ng/ml while mean value in control group was 2.9 ng/ml(p< 0.001). Mean CK-MB values in Stage 1, stage 2 and stage 3 of Hypoxic Ischemic Encephalopathy (HIE) were 8.69 ± 2.85 ng/ml, 11.03 ± 4.46 ng/ml and 24.85 ± 19.13 ng/ml, respectively(p< 0.001). Mean Troponin-I value in neonates with perinatal asphyxia was 0.18 ng/ml, while mean value in control group was 0.02 ng/ml (p< 0.001) Mean Troponin I values in Stage 1, stage 2 and stage 3 were 0.09 ± 0.04 ng/ml, 0.17 ± 0.07 ng/ml and 0 .26 ± 0.08 ng/ml, respectively (p< 0.001). Mean BNP level in neonates with perinatal asphyxia was 1111.2 ± 663.1 pg/ml while in control group it was 253.2 ± 86.1 pg/ml(p< 0.001). Mean BNP Values in Stage 1, stage 2 and stage 3 were 482.40 ± 114.83 pg/ml, 957.00 ± 336.94 pg/ml and 1823.27 ± 477.91 pg/ml , respectively(p< 0.001). CK-MB, cTnI and BNP levels were significantly higher among vasopressor recipients as compared to the non-recipients (p value < 0.01, <0.001, and < 0.001, respectively) Neonates who died had significantly higher level of CK-MB, cTnI and BNP (p value <0.001, <0.05 and <0.05 respectively) in comparison to patients who recovered and discharged. Significantly lower values of RVEF and LVEF were found with increasing grades of HIE (p<0.05 and <0.05 respectively). Myocardial dysfunction secondary to perinatal asphyxia is much more frequent than thought and it requires high index of suspicion. Thus, an early detection of myocardial dysfunction and prompt cardiovascular support will help in improving prognosis of these asphyxiated newborns.