VALUE OF MYOCARDIAL HYPOXIA MARKERS (CREATININE KINASE AND ITS MB-FRACTION, TROPONIN-T, QT-INTERVALS) AND SERUM CREATININE FOR THE RETROSPECTIVE DIAGNOSIS OF PERINATAL ASPHYXIA

Neonatal asphyxia is a major topic of neonatal. research. However, no clear-cut physiologic parameters exist which enable an early identific ation of neonatal infants who are either at risk to develop brain dama ge or posthypoxic heart failure. Parameters indicating dysfunction of the heart and kidneys as creatinine and creatinine kinase have been ev aluated. In our study, 47 asphyxiated infants (umbilical artery pH <7. 18 and either a 1-min Apgar score <4 or a 5-min Apgar score <7) were c ompared to 27 nonasphyxiated controls regarding significant difference s in creatinine, creatinine kinase, its MB fraction, and a newly intro duced myocardial hypoxia indicator - troponin T - to establish the val ue of these parameters in the retrospective diagnosis of asphyxia. Fur ther we evaluated two subsets of these 47 asphyxiated infants with eit her subsequent signs of encephalopathy (seizures) or heart failure. Cr eatinine, creatinine kinase and troponin T were significantly elevated in asphyxiated infants compared with controls; no differences were fo und in creatinine kinase and its MB fraction. In asphyxiated infants w ith heart failure, troponin T was significantly higher than in the oth er asphyxiated infants. However, none of the parameters studied was si gnificantly different in patients with brain damage compared with asph yxiated infants without neurological sequelae. Troponin T has a high p ositive predictive value in the postnatal diagnosis of asphyxia. The d iagnostic power of troponin T equals that of creatinine. However, trop onin T is more sensitive in the identification of infants with asphyxi a and cardiocirculatory failure than creatinine. Creatinine kinase and its MB fraction have no diagnostic value.