A possible role of troponin I, copeptin and ischemia-modified albumin in prognosis of the development of post-hypoxic myocardial damage in newborns

Abstract

Aim: The aim was to improve the prediction of the development of post-hypoxic myocardial damage in newborns with asphyxia of varying degrees, by comparing the levels of troponin I, copeptin, and ischemia-modified albumin (IMA), to study their correlation with Holter monitoring and echocardiography.

Materials and methods: The study involved the examination of 94 neonates in the early neonatal period, assessment of history data, umbilical blood sampling with determination of levels of troponin I, copeptin, IMA, Holter monitoring, echocardiography.

Results: Depending on the diagnosis of asphyxia at birth, infants were divided into 2 main groups: Group 1 (n = 50) included newborns with asphyxia and Group 2 (n = 44) without asphyxia. Depending on the severity of asphyxia, Group 1 newborns were divided into subgroups: Group 1a (n = 16) with severe asphyxia, Group 1b (n = 34) with moderate asphyxia. The study showed that the risk factors for the development of hypoxic events in Group 1 infants (RR = 4.787, 95% CI [1.650; 13.887], χ² = 18.049; p < 0.001) were obstetric and gynecological complications in newborn’s mothers. Daily ECG monitoring, conducted at the age of 1-2 days, determined that 84% of Group 1 newborns had different variants of cardiac rhythm and conduction abnormalities. Assessment of the levels of biochemical markers in the umbilical cord blood showed that the levels of copeptin (p1a,2 = 0.0008; p1a,1b = 0.0093) and IMA (p1,2 = 0.00000039; p1a,2 = 0.000025; p1a,1b = 0.022769; p1b,2 = 0.001870) were the highest in newborns with severe asphyxia, as compared both to the comparison group, and the group of infants with moderate asphyxia. Increased levels of troponin I were also found in the group of infants with asphyxia, especially severe, but no statistically significant difference in the rates among the groups was obtained. Interconnections between the levels of biochemical markers and a range of Holter monitoring and echocardiography parameters in newborns with asphyxia of different degrees at birth were obtained.

Conclusions: Assessment of laboratory-instrumental findings concerning the levels of troponin I, copeptin, and IMA in newborns showed that determination of copeptin levels and IMA could provide an opportunity for early prediction of the development of post-hypoxic disorders of the cardiovascular system in newborns.