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Serum troponin in neonatal intensive care
Afif F El-Khuffash1, Eleanor J Molloy
1Department of Neonatology, National Maternity Hospital, Dublin, Ireland. afif_faisal@hotmail.com
Insights
Cardiac troponins are vital for diagnosing myocardial ischemia in children and adults. This review explores their use in neonates, particularly for assessing myocardial injury and guiding treatment strategies.
Area of Science:
- Biochemistry
- Pediatric Cardiology
- Neonatology
Background:
- Cardiac troponins are established biomarkers for myocardial ischemia and infarction in adults.
- Their utility extends to pediatric populations, correlating with myocardial damage and predicting outcomes after cardiac surgery or cardiotoxic medication.
- Reference values and applications in neonatal care are less defined but hold significant potential.
Purpose of the Study:
- To review established reference values for cardiac troponins in term and preterm infants.
- To explore the potential applications of cardiac troponins in neonatology, including assessment of myocardial injury.
- To highlight areas for future research regarding troponin's prognostic role and response to cardioprotective strategies in neonates.
Main Methods:
- Literature review of studies on cardiac troponin use in pediatric and neonatal populations.
- Discussion of established reference values and correlation with clinical outcomes.
- Exploration of troponin's potential role in specific neonatal conditions and comparison with echocardiography.
Main Results:
- Cardiac troponins correlate well with myocardial damage extent and prognosis in pediatric patients.
- Established reference values exist for term and preterm infants, suggesting potential clinical utility.
- Troponins may serve as an adjunct diagnostic tool in neonatal conditions like respiratory distress syndrome and asphyxia, especially where echocardiography is unavailable.
Conclusions:
- Cardiac troponins are valuable in pediatric cardiology and show promise in neonatology for assessing myocardial injury.
- Further research is required to fully establish their prognostic role and guide treatment monitoring in neonatal populations.
- Investigating the impact of inotropes on myocardial function using troponins in preterm infants is a key area for future study.
Abstract:
Cardiac troponins have a major role in screening and diagnosis of myocardial ischaemia in adults and children. Their introduction has redefined the diagnosis of myocardial infarction in adults and provided valuable prognostic information. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication, and can be used as predictors of subsequent cardiac recovery and mortality. This review discusses the current established reference values in term and preterm infants and demonstrates their potential use in neonatology. They may serve as a useful adjunct in the assessment of the magnitude of myocardial injury in respiratory distress syndrome and asphyxia. They may also benefit centres without on-site echocardiography with some evidence showing good correlation with echo-derived markers of myocardial function. The use of troponins in the neonatal unit remains a research tool. More work is needed to explore their prognostic role and monitoring response to treatment following cardioprotective strategies. In preterm infants the effect of inotropes on myocardial function needs further study and troponin may form an integral part of this research.
