title: Assessment of myocardial dysfunction in neonates with hypoxic-ischemic encephalopathy: is it a significant predictor of mortality?
abstract: OBJECTIVE
  Hypoxic-ischemic cerebral injury due to perinatal asphyxia is an important cause of neonatal mortality and morbidity. To predict who will survive or die due to this disorder still remains obscure. The aim of this study is to evaluate the predictive value of myocardial involvement in the assessment of mortality for the neonates with hypoxic-ischemic encephalopathy (HIE).
  
  
  METHODS
  The study included 34 term newborns fulfilling the diagnostic criteria for HIE and staged according to Sarnat and Sarnat classification. To assess the myocardial involvement, electrocardiogram (ECG) and echocardiogram (Echo) were performed in the first 24-48 h of life. In addition, serum Troponin I and creatine kinase-myocardial band (CK-MB) were measured at delivery and postnatal day 3.
  
  
  RESULTS
  Of the 34 cases, 19 (55.9%) were stage in 1, 9 were in (26.4%) stage 2 and 6 (17.6%) were in stage 3 HIE. Nine (26.4%) patients died of the disease. Thirteen patients (38.2%) showed ECG findings related to perinatal asphyxia. Only one patient had mild Echo changes. Higher Troponin I level was a significant predictor of mortality, whereas CK-MB did not show any significant predicting value. Troponin I test showed 33% sensitivity and 80% specificity in predicting mortality. In addition, the sensitivity and specificity of ECG as a predictor of mortality were 77 and 76%, respectively.
  
  
  CONCLUSIONS
  This study highlights the significance of monitoring cardiac functions in newborns with HIE. ECG changes and serum Troponin I level at 72 h after birth are likely to have significant predictive value in the assessment of mortality in HIE. Further studies will provide additional data for the long-term prognostic value of cardiac functions in this disorder.
authors.affiliation: Clinics of Pediatrics, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Kanik
authors.forename: Esra Arun
authors.initials: EA
authors.lastname: Ozer
authors.forename: Ali Rahmi
authors.initials: AR
authors.lastname: Bakiler
authors.forename: Halil
authors.initials: H
authors.lastname: Aydinlioglu
authors.forename: Coskun
authors.initials: C
authors.lastname: Dorak
authors.forename: Buket
authors.initials: B
authors.lastname: Dogrusoz
authors.forename: Ali
authors.initials: A
authors.lastname: Kanik
authors.forename: Isin
authors.initials: I
authors.lastname: Yaprak