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Abstract
Summary
Hypoxic-ischemic encephalopathy (HIE) refers to the neurological signs and symptoms that are induced by hypoxia and ischemia. Hypoxia may result from ischemia (i.e., a lack of sufficient blood flow to all or part of an organ), insufficient inspired oxygen, or inadequate blood oxygen-carrying capacity (e.g., inadequate oxygen in inspired air, severe anemia, carbon monoxide poisoning).
In spite of major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxic-ischemic encephalopathy (HIE), remains a serious condition, causing significant mortality and long-term morbidity. HIE is an acquired syndrome characterized by clinical and laboratory evidence of acute brain injury due to asphyxia (i.e., hypoxia, acidosis).
Severe birth asphyxia may result in cardiomyopathy; cadiomyopathy being defined by abnormally reduced systolic contractile function or abnormal diastolic function. As asphyxia has been associated with hypoxemia, acidemia, polycythemia and\ or pulmonary arterial hypertension, it has been suggested that one or more of these metabolic or hemodynamic alterations may be fundamental in producing the cardiomyopathy .
Cardiac troponin is a complex consisting of three single-chain polypeptides: troponin-I (cTnI), which prevents muscle contraction in the absence of calcium; troponin-T (cTnT), which connects the troponin complex to tropomyosin; and troponin-C, which binds calcium. Together with tropomyosin and under the influence of calcium, troponin regulates muscle contraction.
This study was conducted at Suez Canal University Hospital and included 80 newborn infants (40 who assessed at birth and had clinical evidence of HIE & 40 normal newborn infants).
All the studied cases were subjected to:
Detailed history taking including :
1-Identification data:
neonatal history (age, sex, time of birth, order between siblings).
2-Perinatal history:including:
mother age, duration of pregnancy, drug exposure during pregnancy, complication during pregnancy, mode of delivery,complication during labour.
3-Apgar score (score to evaluate the newborn infant)
Full clinical examination of studied cases:
Meticulous general & systemic examination were performed including neonatal reflexes, chest, heart, abdominal and neurological examination.
Grading according to Sarnat H & Sarnat M,1976:
Investigations:
Measurement of serum Cardiac Troponin I & Arterial Blood Gases
The study results were:
In group A ;
Forty asphyxiated neonates (HIE group); 65% was male neonates , 35% was female neonates. 97.5% showed increased serum cardiac troponin I . 32.5% was grade I, 40% was grade II, 27.5% was grade III. Finally regarding outcome 67.5% were discharged alive, 32.5% died.
In group B;
Forty control normal healthy neonates; 37.5% was male neonates , 62.5% was female neonates. Regarding maturity 100% was fullterm. 100% showed normal serum cardiac troponin I . Finally regarding outcome 100% were discharged alive.
As regards the Cardiac Troponin I serum level in our study, 97.5% of the HIE group had high Cardiac Troponin I serum level (with range of 0.4 – 12.3 ng/ml ). Serum Cardiac Troponin I is significantly higher in HIE group rather than in the control group.
There is a strong relationship between the serum cardiac Troponin I level in the neonates with Hypoxic Ischemic Encephalopathy and the short term outcome of those neonates.
There is a significant relation between cardiac troponin I & the grade of hypoxic ischemic encephalopathy (HIE), yet we found weak correlation between them.
There is a no correlation between cardiac troponin I & Apgar score in 1st.minute among cases with HIE. On the other hand there is a weak inverse correlation between cTnI and Apgar score at 5th.minute.
There is a strong relation between cardiac troponin I & the outcome of studied cases, (serum cardiac troponin I increased among expired HIE cases compared to survival).
Serum cardiac troponin I as an early predictive measure to predict the short term outcome of HIE.
from this study cardiac troponin I found to be a sensitive marker & early prediction of outcome for HIE.