Cardiac biomarkers as indicators of hemodynamic adaptation during postasphyxial hypothermia treatment.
BACKGROUND
Little is known about the effects of hypothermia on the cardiovascular system in term newborns with neonatal encephalopathy.


OBJECTIVE
To evaluate whether mild hypothermia for neonatal encephalopathy is cardioprotective as indicated by the cardiac biomarkers cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP).


METHODS
This was an observational cohort study of infants treated for perinatal asphyxia. In infants, mild total body hypothermia treatment of 33.5°C during 72 h was initiated (n = 20). Samples of cTnI and BNP were collected before the start of hypothermia, at 24 and 48 h after birth, and after rewarming (84 h). BNP and cTnI values were then compared with BNP and cTnI values of asphyxiated infants not treated with hypothermia (n = 28).


RESULTS
No differences were found between the groups in clinical patient characteristics or inotropic support. The hypothermia-treated patients seemed to be clinically more affected (5-min Apgar score, p < 0.05; umbilical artery pH, p = 0.08), but showed similar encephalopathy scores. Significantly lower values for BNP were found in hypothermia- compared to nonhypothermia-treated infants at 48 h and at normothermia after rewarming [144 pmol/l (95-286) vs. 75 pmol/l (45-143), 182 pmol/l (73-341) vs. 43 pmol/l (24-163)]. No differences were found for cTnI concentrations between both groups.


CONCLUSIONS
The raised, but similar, cTnI values between hypothermia- and nonhypothermia-treated infants indicate similar myocardial damage in both groups. The lower BNP levels during hypothermia treatment suggest that hypothermia after perinatal asphyxia exerts a beneficial effect on cardiac function.
Department of Neonatology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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DC
Vijlbrief
M J N L
MJ
Benders
H
H
Kemperman
F
F
van Bel
W B
WB
de Vries
D000222:Adaptation, Physiological / Q000502:physiology; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000097:blood / Q000150:complications / Q000628:therapy*; D015415:Biomarkers / Q000097:blood*; D009202:Cardiomyopathies / Q000097:blood / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D020925:Hypoxia-Ischemia, Brain / Q000097:blood / Q000209:etiology / Q000628:therapy*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain