Avicenna Journal of Clinical Medicine
Avicenna J Clin Med, 2022; 29(1): 12-17
Asadolah Tanasan1,3 , Mohammad Kazem Sabzehei1,* , Pegah Ameri1, Ali Amri2, Fatemeh Yaghoubi2, Hossein Ariana1
Background and Objective
Preterm delivery accounts for about 8-10% of all births and is responsible for 60-80% of deaths among infants without congenital anomalies worldwide . … [2-4]. Patent ductus arteriosus (PDA) in these babies is the most important cause of cardiac dysfunction [5, 4]. … .
Therefore, the diagnosis and determination of cardiac disorders and primary supportive care play an important role in the prognosis of these infants. Disorders in myocardial contraction and cardiac output are common complications of respiratory distress syndrome in premature infants . … [5, 6, 8].
Considering these cases, the need for simple diagnostic methods has led to the investigation of cardiac biological markers, including troponin, in premature infants [10, 9]. … [11-13].
Several studies of biomarkers in infants showed their usefulness in determining prognosis before and after the treatment of cardiopulmonary problems . Meanwhile, the diagnosis of premature myocardial functional disorders in premature babies improves the prognosis of these patients by performing early treatment [15, 13]. For this purpose, this study was conducted to determine the relationship between troponin T level and the prognosis of premature infants admitted to the neonatal intensive care unit (NICU) of Fatemieh Hospital, Hamadan, Iran.
Materials and Methods
This cross-sectional study was conducted in Fatemieh Hospital in Hamadan, Iran, in 2018. The records of all 61 preterm infants who were admitted to the NICU department of Fatemieh Hospital in one year (from May 2018 to May 2019) that were subjected to the measurement of serum troponin T levels were examined in the form of a census. The information entered into the checklist included gender, intrauterine age, troponin T level, and factors related to the short-term prognosis of infants, such as PDA status, duration of NICU hospitalization, intraventricular hemorrhage, hemoglobin level, pneumothorax, and findings of Arterial Blood Gas (ABG) in different days and deaths reports. Considering the importance of the PDA presence in premature babies, babies were divided into three categories of large PDA that needed treatment with Apotel, small PDA that needed no treatments, and babies without PDA.
A total of 61 babies were included in the study, and the mean gestational age was calculated at 31.5 ± 3.2 weeks, birth weight was 1647 ± 554 g, and troponin level was measured at 330 ± 345 pg/ml. The relationship of troponin level with gestational age (P=0.526) and birth weight (P=0.316) was not statistically significant. Moreover, 22 patients had a large PDA with a troponin level of 436 ± 50.2 pg/ml, 14 patients had a small PDA with a troponin level of 260.5 ± 89.8 pg/ml, and 25 patients were without PDA with a troponin level of 277.1 ± 229.7 pg/ml (P=0.203). No statistically significant difference was observed between the three groups. The mean levels of troponin were 423 ± 521 and 274 ± 154 pg/ml in the deceased and surviving neonates, respectively [P=0.194; Table 1].
Inotrope intake was significantly higher in the deceased patients (P=0.003), and troponin T level was statistically significantly related to the inotrope intake (P=0.008). Due to little difference, the relationship between troponin level and severe acidosis was not significant (P=0.051), which is valuable from a clinical point of view. The results of comparison of the risk factors with the prognosis of the studied infants are shown in Table 2.
[1-20]…. In a study similar to the current research conducted by Asrani et al.  in 2017, the mean troponin level in infants with PDA was higher than in infants without PDA, as in the present study. Although this difference was significant in the mentioned study, the level of troponin before and after treatment was not significantly different. In our study, the relationship of troponin level with gestational age and birth weight was not significant, which is not in line with the results of the mentioned study. In both studies, the level of troponin in premature infants, both in the groups of with and without PDA, was 14 pg/ml higher than the level declared by international guidelines for managing the medical infarction for myocardial infarction.
The troponin level in infants with and without PDA in a study conducted by Asrani et al. was 251.5 ± 65.6 and 161 ± 22.4 pg/ml, respectively, and in our study it was 436 ± 50.2 and 277.1 ± 229.7, respectively. In comparison with the abovementioned study, the amount of troponin in our patients, both in the study group and in the control group, was almost two times higher than the Asrani et al. s’ study. The comparison of the troponin levels in the deceased and surviving patients showed the deterioration of the infants’ health in our study. Despite the high level of troponin in the group of the deceased patients, 423 ± 521 vs. 274 ± 154 pg/ml in the surviving patients, this difference was not statistically significant as this value is higher than the sensitive level of troponin T declared as 14 pg/ml in patients with myocardial infarction in adults .
In our study, the gestational age of infants with large PDA was lower than other infants and the birth weight was significantly lower than other infants. Although these differences was not significant in the deceased babies, the gestational age and birth weight were lower compared to the alive infants. These cases, along with large PDA, were the clinical causes of the malaise of the infants in the present research. Some studies showed that high serum troponin levels in premature babies with PDA are related to myocardial dysfunction, and successful treatments in the first 48 h have an effect on troponin levels .
Troponin T is a valuable biomarker in determining myocardial dysfunction in premature infants with PDA, and its increase in patients with hemodynamic disorders is associated with a poor prognosis.
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