الفهرس 
Review of literatureOnly 14 pages are availabe for public view
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Abstract
Summary& conclusion Summary and conclusion Respiratory distress and perinatal asphyxia are common causes of neonatal morbidity and mortality. Cardiovascular compromise is common among neonatal respiratory distress and perinatal asphyxia. Impaired myocardial contractility and low cardiac output are common complications of such conditions. Cardiac abnormalities in neonatal respiratory distress and perinatal asphyxia are often under diagnosed and requires a high index of suspicion.Biochemical markers are more sensitive and specific than imaging techniques in the diagnosis of myocardial necrosis. Several studies have indicated the use of troponin in a broader range of clinical settings in neonatal medicine. cTnT and cTnI are currently used as biochemical markers for myocardial ischemic changes in adults, but their clinical significance in neonates is still questioned.In recent years there is growing interest in the use of cardiac troponin I “cTnI” in assessing cardiac injuries in neonatal respiratory distress and perinatal asphyxia. cTnI is the subunit that inhibits actomyosin ATPase activity, preventing muscle contraction in the absence of Ca+2, blocks the formation of actin-myosin bridges.Cardiac TnI (cTnI) is found in the atria and ventricles, and contains an immunologically distinct N-terminus amino chain that is not expressed in the skeletal forms. CTnI is released into the circulation in response to ischemic and non-ischemic cardiac injury. Serum cTnI that is detected using monoclonal antibodies was found to be a very sensitive and specific marker of cardiac injury in neonatal respiratory distress and perinatal asphyxia.140 Summary& conclusion Aim of the work:To evaluate the importance of serum cardiac troponin I (cTnI) measurement in neonates suffering from respiratory distress and perinatal asphyxia as a marker for cardiac injury in such neonates and its correlation with the severity of underlying diseases. Patients and methods:The Present study was conducted in NICU of shebein El- Kom teaching hospital and Menoufiya University hospital in the period from October 2009 to December 2010.This study included 2 groups:Patient group: which are divided into two groups:GroupI: includes 40 cases of preterm and fullterm neonates with respiratory distress, they were 20 males and 20 females and their mean gestational age was 35 ± 3 weeks, they were further subdivided according to Down score into:• GroupI a: With mild degree respiratory distress (n =13).• GroupI b: With moderate degree respiratory distress (n =13)• GroupI c: With severe degree respiratory distress (n =14). Group II: Includes 30 cases of fullterm neonates with perinatal asphyxia, they were 22 males and 8 females and and their mean gestational age was 38 ± 2 weeks, they were further subdivided according to sarrnat stage int• GroupII a: With mild degree perinatal asphyxia (n =10)• GroupII b: With moderate degree perinatal asphyxia (n =10).• GroupII c: With severe degree perinatal asphyxia (n =10). Control group: includes 20 apparently healthy fullterm and preterm neonates for comparison.141 Summary& conclusion Newborns with neonatal sepsis and congenital heart disease were excluded from the study to avoid their effect on serum cardiac troponin I.All neonates included in the study were subjected to:• Full perinatal history.• Complete clinical assessment.• Full investigations: including chest X-ray, Laboratory workups (blood samples were taken from the neonates for ABG, CBC, CRP and serum troponin I). The results: of the present study showed:• As regard the demographic data: Group I (respiratory distressed newborns): there were no statistically significant difference as regard sex, gestational age, birth weight and Apgar score at 1 and 5 minutes between them and control group. Group II (Asphyxiated newborns): there were no statistically significant difference as regard sex, while the birth weight and gestational age are significantly higher than control group. On the other hand, Apgar score at 1 and 5 minutes are significantly lower than the control group• As regard the obstetric data: Group I (respiratory distressed newborns): have significant higher percentage of obstetric problems such as PROM and antepartum hemorrhage than control group.Group II (Asphyxiated newborns): have significant higher percentage of obstetric problems compared to control group including meconium stained liquor (50%) was the most frequent obstetric problem associated with perinatal asphyxia in our study followed by obstructed labour (46.7%) then antepartum hemorrhage (16.7%), premature rupture of membrane (6.7%) and cord around the neck (6.7%). Summary& conclusion• As regard the Clinical data of the studied groups: Group I (respiratory distressed newborns): have significantly higher percentage of patients with tachypnea, tachycardia and those needing respiratory support than control group. Group II (Asphyxiated newborns): have significantly higher percentage of patients with clinical disturbance regarding (heart rate, respiratory rate, perfusion, blood pressure, consciousness, tone and reflexes, presence of seizures and Respiratory support) than control group As Regard the laboratory data of the studied groups:Group I (respiratory distressed newborns): revealed as regard to: Complete blood picture in this work: showed that there is significant decrease in both Hb level and RBCs count than control group.Arterial blood gases (ABG): showing that there were statistical significant reduction in arterial blood gases parameters (↓pH, ↓paO2 mmHg and↑paCo2 mmHg) among infants with respiratory distress compared with that of the control group. serum Cardiac troponin I (cTnI): In the present study cTnI was used to detect myocardial affection in respiratory distressed newborns as we found high statistical significant increase of troponin I level (ng/ml) among respiratory distressed group (0.57 ± 0.44 ng/ml) in comparison with control group (0.01 ± 0.002 ng/ml) and this elevation was positively correlated with the degree of respiratory distress (0.07 ± 0.03, 0.5 ± 0.11, 1.09 ± 0.11ng/ml for mild, moderate and severe respiratory distress respectively). Morever, cardiac troponin I had no significant correlations with gestational age, birth weight, heart rate, blood pressure parameters and CBC parameters (Hb, RBCs, WBCs and platelets) .While cardiac troponin I had significant positive correlations with (down score of respiratory distress and PaCO2) and there is significant 143 Summary& conclusion negative correlations present between troponin I and (Apgar score, pH and PaO2) amomg respiratory distressed newborns. Among all variables that have significant correlations with serum troponin I within respiratory distressed groups, only changes in Down score of respiratory distress can attribute to significant changes in serum troponin I suggesting that the cardiac function was demonstrated to be influenced by the severity of respiratory distress and its ventilatory management. Furthermore, the results of the present study revealed that there is statistical significant correlation between cTnI level and mortality among respiratory distressed newborns and we found that the optimal cTnI cut-off value in predicting mortality risk among respiratory distressed newborns were 0.63 ng/ml with a 79% sensitivity; and 75% specificity.Group II (Asphyxiated newborns): revealed as regard to Complete blood picture in this work: showed that there is significant decrease in both Hb level, RBCs count and platelet count than control group.Arterial blood gases (ABG): showing that there were statistical significant reduction in arterial blood gases parameters (↓pH, ↓paO2 mmHg, ↓ HCO3 and ↑paCo2 mmHg) among asphyxiated group compared with that of the control group.Serum Cardiac troponin I (cTnI): In the present study cTnI was used to detect myocardial affection in asphyxiated newborns as we found that serum cTnI was significantly elevated in newborns with perinatal asphyxia (0.43 ± 0.31 ng/ml) compared to that of healthy newborns (0.01 ± 0.002 ng/ml) and this elevation was positively correlated with the degree of hypoxic ischemic encephalopathy (0.08 ± 0.02, 0.34 ± 0.04, 0.83 ± 0.04 ng/ml for mild, moderate and severe HIE respectively). Morever, cardiac troponin I had no significant correlation with gestational age, birth weight, mode of delivery and apgar score at 1 min and Hb level, RBCs and WBCs parameters of CBC while cardiac troponin I had positive correlation with (PCO2 and Sarranat staging) and there is significant negative correlations present between troponin I and (Apgar score at 5 min, heart rate, blood pressure, platelets, pH, PO2 and HCO3). Among all variables that have significant correlations with serum troponin I within asphyxiated newborns, only changes in sarranat staging of asphyxia can attribute to significant changes in serum Troponin I as cTnI levels increased significantly with increased severity of Sarrnat stages at birth. Furthermore, the results of the present study revealed that there is statistical significant correlation between cTnI level and mortality among asphyxiated newborns and we suggested that the optimal cTnI cut-off value in predicting mortality risk among asphyxiated newborns were 0.36 ng/ml with a 70% sensitivity; and 80% specificity.Conclusion• Neonates with perinatal asphyxia and respiratory distress have significantly higher serum cTnI levels compared to healthy ones at birth, representing an early diagnostic marker, that can help in early detection of cardiac injury during the course of respiratory distress and perinatal asphyxia.• Increased cTnI levels in neonates with HIE and respiratory distress have a highly significant relation to an increase in Sarnat staging of HIE and down score of respiratory distress representing an early predictor for the severity of hypoxic-ischemic brain insult in newborns with perinatal asphyxia as well as an early predictor for the severity of respiratory distress, that can help in early intervention to prevent or even limit dangerous and bad sequalae of perinatal asphyxia and respiratory distress. In addition, it could be used in detection of prognosis of cases as high cTnI levels at 0.63, 0.36 ng/ml indicates poor prognosis and increased mortality rates among both respiratory distressed and asphyxiated newborns respectively.