Clinical Spectrum of Neonatal Encephalopathy and the Role of CK-MB Assay in Transient Myocardial Ischaemia in Neonates with Hypoxic Ischaemic Encephalopathy: A Prospective Cohort Study
Introduction: Significant advancements have been made in the field of perinatal medicine through the use of newer monitoring technologies. However, birth asphyxia continues to cause prolonged hospitalisation due to multiple organ dysfunction and unfortunately, sometimes results in death. An elev...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18363/41407_CE[Ra1]_F(IS)_PF1(HB_KM_OM)_QC(AB_IS_OM)_PFA(KM_OM)_PB(HB_KM)_PN(KM).pdf |
| Summary: | Introduction: Significant advancements have been made in the
field of perinatal medicine through the use of newer monitoring
technologies. However, birth asphyxia continues to cause
prolonged hospitalisation due to multiple organ dysfunction and
unfortunately, sometimes results in death. An elevation of the
serum Creatine Kinase Myocardial Bound (CK-MB) fraction in
myocardial ischaemia could indicate exposure to asphyxia and
shock in neonates.
Aim: The aim of this study was to examine the clinical spectrum
of Neonatal Encephalopathy (NE) and investigate Transient
Myocardial Ischaemia (TMI) in neonates with Hypoxic Ischaemic
Encephalopathy (HIE) using CK-MB assay at birth, 24 hours,
and 72 hours.
Materials and Methods: A prospective clinical study was
conducted in the Neonatal Intensive Care Unit (NICU) at a
Tertiary Care Hospital in Tamil Nadu, India. The study duration
was eight months, from January 2014 to August 2014. A total of
70 term neonates admitted with NE symptoms were included.
Among them, 65 babies with evidence of asphyxia, such as an
Appearance, Pulse, Grimace,Activity and respiration (APGAR)
score less than 3 at five minutes, heart rate less than 60 Beats
Per Minute (bpm), meconium-stained amniotic fluid, or the
need for positive pressure ventilation for more than one minute,
were evaluated for TMI. Myocardial involvement was assessed
through clinical evaluation, chest X-ray (CXR), Electrocardiogram
(ECG), Echocardiography (ECHO), and CK-MB assay at birth, 24
hours, and 72 hours. Statistical analysis was performed using
Epi Info software version 7.0.
Results: The mean Gestational Age (GA) of the study
participants was 38.97±1.31 weeks. During the study period,
70 babies were admitted with NE symptoms, and HIE was the
cause of encephalopathy in 65 babies. Other causes included
hypoglycaemia, intraventricular haemorrhage, and bilirubin
encephalopathy. Meconium staining of amniotic fluid was the
most common intrapartum event in HIE babies. The survival rate
in encephalopathy cases was 28.57%. Shock and respiratory
failure were common complications in HIE, representing
46.15% and 44.61% respectively. Cardiomegaly in CXR, ST
depression in ECG, Tricuspid Regurgitation (TR) in ECHO, and
elevated CK-MB were commonly detected in babies with TMI
associated with HIE.
Conclusion: NE caused by HIE has a high mortality and
morbidity rate. 83.3% of asphyxiated babies with shock had
elevated CK-MB levels at birth, but the CK-MB values at 24
hours and 72 hours were not significantly elevated. |
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| ISSN: | 2249-782X 0973-709X |