title: Cardiac Troponin Levels in Neonates Who Require ECMO for Noncardiac Indications Are Elevated in Nonsurvivors.
abstract: OBJECTIVE
  The aim of the study is to determine the utility of cardiac troponin (cTnI) as a marker of mortality and morbidity in newborn infants who require extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  Retrospective medical chart analysis of term or near-term newborn infants treated with ECMO from 2002 to 2012 at a single Level III neonatal intensive care unit. Data analyzed included serial serum cTnI measurements, clinical and demographic characteristics, pre-ECMO laboratory values, and ECMO laboratory values and outcomes.
  
  
  RESULTS
  Survival (27/46) was significantly related to birth weight (3,413.9 ± 662.3 vs. 2,667.7 ± 478.3 g, p < 0.001), outborn status (22/30 vs. 5/13, p = 0.0021), and the absence of a congenital diaphragmatic hernia (22/30 vs. 5/18, p = 0.0021). Mean peak cTnI did not differ between survivors and nonsurvivors but when peak cTnI was < 2.8 ng/mL, survival was 64% compared with 22% when it was > 2.8 ng/mL (p = 0.0224; odds ratio = 0.160, 95% confidence interval = 0.0292-0.8778). By multivariate analysis, peak cTnI > 2.1 was a significant risk factor for nonsurvival, p = 0.0497. The area under the curve of a receiver-operator analysis using peak cTnI > 2.1, birth weight, and birthplace was 0.89, p < 0.001.
  
  
  CONCLUSIONS
  cTnI is an independent biomarker for poor outcome in neonates who receive ECMO therapy for noncardiac generations.
authors.affiliation: Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Astoria
authors.affiliation: Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia.
authors.forename: Simon E
authors.initials: SE
authors.lastname: Karam
authors.affiliation: Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Moores
authors.affiliation: Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Rozycki
mesh_terms: D015415:Biomarkers; D001724:Birth Weight; D002423:Cause of Death; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000628:therapy*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000628:therapy*; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I