Cardiac troponin T as a diagnostic marker of hypoxic myocardial injury in sick full-term and preterm neonates

Perinatal asphyxia is associated with cardiac dysfunction; this may be secondary to myocardial ischemia. Also, in preterm infants with respiratory distress syndrome, cardiac function is negatively influenced by the severity of lung disease. Cardiac troponin T [cTnT] is the ideal marker used in the detection of myocardial injury. The aim of the present work was to provide evidence of the usefulness of cTnT in the diagnosis of myocardial injury in neonates after intrauterine hypoxia or with respiratory distress syndrome. Forty five neonates were enrolled in the study and were divided into three groups: group I, fifteen full-term neonates with perinatal asphyxia; group II, fifteen preterm neonates with respiratory distress syndrome; and control group, fifteen healthy full term neonates. Arterial blood gases were measured for sick neonates; serum cTnT was assayed and echocardiography was performed for all neonates. Serum cTnT levels were significantly higher in sick neonates [groups I and II] than the control group [P<0.001]. There was significant correlation between cTnT levels and arterial blood gases [pH, PO[2], PCO[2], HCO[3]] and also with echocardiographic parameters of ventricular function [FS% and EF%] [P<0.01]. cTnT is a useful diagnostic marker used for assessment of post hypoxic myocardial injury in fullterm neonates with perinatal asphyxia or preterm neonates with respiratory distress syndrome

Plasma adrenolutin as a marker of increased oxidative stress in children with severe chronic heart failure

The objective of this study was to measure the plasma levels of a marker of oxidative stress [adrenolutin, the oxidative product of catecholamines] and oxidative defenses [antioxidants; vitamin E and C] in children with chronic congestive heart failure [CHF], and to determine the prognostic value of adrenolutin in these patients, A total of 45 children with chronic CHF [>/= 6 months], with a mean age of 6.0 +/- 2.4 years, were enrolled in the study. They included: Ross class II [13 patients], class III [15 patients], and class IV [17 patients]. Twenty healthy children served as a control group. Clinical and echocardiographic assessment was performed for every patient. Plasma adrenolutin, norepinephrine, and epinephrine levels were measured using high-performance liquid chromatography [HPLC], and plasma vitamin E and C levels were assayed. The relation of plasma adrenolutin levels to prognosis was evaluated at follow up period of 6 months. The results showed significantly higher plasma adrenolutin and catecholamine levels in children with chronic CHF as compared to controls, and increased with the severity of the disease with the highest levels in Ross class III and IV patients [P<0.05]. Plasma adrenolutin levels were significantly higher in children with poor prognosis or death during follow-up [P<0.01]. Plasma antioxidant levels [Vitamin C and E] significantly decreased with the severity of chronic CHF and When compared to controls [P<0.05]. There was a significant negative correlation between plasma adrenolutin and vitamin C levels [P<0.05]. Plasma adrenolutin is significantly increased in children with severe chronic CHF, as a marker of increased oxidative stress, and it is associated with a poor prognosis or death; whereas plasma antioxidants [Vitamin C and E] significantly decrease with increasing severity of chronic heart failure. Antioxidant supplements maybe of therapeutic benefit in patients with chronic CHF

Plasma carnitine as a diagnostic marker at impaired left ventricular function in children with chronic rheumatic heart disease therapeutic role of L-carnitine

L-carnitine plays a major role in fatty acid oxidation and myocardial carnitine deficiency may cause malfunction of the head. Chronic rheumatic heart disease [RHD] can be associated with myocardial dysfunction. The objective of this study was to determine if plasma L-carnitine levels can serve as a diagnostic marker of impaired left ventricular [LV] function in children with chronic RHD, and to study the therapeutic role of L-carnitine in these patients. Forty cardiac patients with chronic RHD, with a mean age of 9.0 +/- 2.2 years, were enrolled in the study. They were classified into 2 groups: group I [with chronic RHD [20 patients], and group II with chronic RHD with congestive heart failure [CHF] [20 patients]. Twenty healthy children served as a control group. Plasma and urinary levels of L-carnitine were measured using Enzymatic UV test. Echocardiographic assessment of LV systolic function was performed [FS% and EF%]. Clinical and echocardiographic data were studied after 6 months of L-carnitine therapy in a group of 20 patients, compared to non-carnitine therapy group [20 patients]. The results showed that plasma and urinary L-carnitine levels were significantly higher in group II children with chronic RHD with CHF as compared to controls and group I patients [P<0.05]. There were significant negative correlations between plasma carnitine levels and echocardiographic indices of impaired LV systolic function [FS% and EF%] [P<0.05]. There was significant improvement of the clinical characteristics and echocardiographic LV systolic dysfunction, 6 months after L-carnitine therapy [P<0.05]. The elevated plasma [and urinary] L-carnitine levels in children with chronic RHD with CHF, can serve as a diagnostic marker of Impaired LV function. L-carnitine therapy may improve the clinical course and the LV systolic dysfunction in patients with chronic RHD

Circulating Thrombopoietin and Interleukin-11 in Thrombocytopenic Neonates with Sepsis

Thrombocytopenia is a commonly encountered hematological complication in neonates with sepsis. Thrombopoietin [TPO] is the major regulator of the platelet production in neonates. It is unique among the haematopoietic cytokines for maintenance of the most primitive haematopoietic stem cells. Interleukin-11[lL-11] stimulates megakaryorytopoiesis and platelet production. The aim of this study was to determine the variation in the TPQ and IL-11 levels and/or if they would correlate with platelet count or not in infected neonates with sepsis. Thirty five neonates with sepsis admitted to the Intensive Care Unit, Pediatric Department, Tanta University Hospital, were enrolled in this study. Twenty healthy neonates sewed as a control group. All these neonates were subjected to the following: Complete blood count [CBC], blood culture, C-reactive protein [CRP], chest X-ray, coagulation studies including prothrombin time, partial thromboplastin time, fibrinogen and D-dimer. Plasma TPO and IL-11 levels were performed using Enzyme-Linked lmmunosorbent Assay[ELISA], The results showed that sick neonates with sepsis had significantly higher plasma levels of both TPO and IL-11 [P<0. 05]. Also, there was significant inverse correlations between the platelet count and TPO and IL-11 levels [r=-0.917 and-0.908 respectively, P value<0.01]. TPO and IL-11 are significantly increased in neonatal sepsis with thrombocytopenia and they are being explored as potential therapeutic agents in these patients

Neonatal cerebrospinal fluid plasminogen and plasminogen activator inhibitor-1 assay as predictors of post hemorrhagic hydrocephalus

Massive intraventricular hemorrhage [IVH] in neonates is followed by progressive ventricular dilatation in 55-80% of cases if the infant survives. The initial mechanism of post hemorrhagic hydrocephalus [PHH] is thought to be obstruction by multiple small blood clots of the channels of the cerebrospinal fluid [CSF] to areas of absorption. Plasminogen activator inhibitor-1 [PAI-1] is the principal regulator of fibrinolysis in blood and one of the most highly controlled of the fibrinolytic components. The aim of this study is to measure plasminogen and plasminogen activator inhibitor-1 levels in the CSF of the neonates after IVH to assess endogenous fibrinolytic activity and to predict the development of post hemorrhagic hydrocephalus. Fifteen full term and preterm neonates with IVH were enrolled in the study. Ten neonates without IVH were used as a control group. Cranial ultrasound was performed at age of 2 weeks and 2 months. Plasma and CSF plasminogen and PAI-1 levels were assessed for these neonates. The results revealed that CSF PAI-1 was significantly higher in infants with IVH than in the controls [P<0.001]. There was no significant difference in the CSF and plasma plasminogen between infants with IVH and controls [p>0.05]. CSF PAI-1 was significantly higher in infants with PHH than in infants with post hemorrhagic ventricular dilatation [p<0.05], with a sensitivity [100%] and specificity [100%]. CSF PAI-1 is a very sensitive and specific parameter than CSF plasminogen for prediction of PHH in neonates with IVH, and this might be useful to evaluate the specific therapeutic programs of these neonates

Plasma natriuretic peptides as predictors of hemodynamically significant patent ductus arteriosus in preterm neonates

The objective of this study was to determine whether the plasma levels of natriuretic peptides in preterm infants with patent ductus arteriosus [PDA] are predictors of the hemodynamic significance of the PDA shunt, and correlate them with clinical and echocardiographic assessment. Fifty preterm neonates, with a mean gestational age of 29.4 wk and weighing less than 1500 g, were enrolled in the study. Based on the clinical and echocardiographic findings, the hemodynamic influence of PDA shunt was classified as: large [8 infants], moderate [10 infants], small [12 infants] or no PDA [20 infants]. Plasma N-terminal atrial natriuretic peptide prohormone [Nt-pro ANP] and brain natrituretic peptide [BNP] were assessed using ELISA kits. The results showed that plasma levels of Nt-pro ANP and BNP significantly increased with the size of PDA shunt, and when compared to infants without PDA [P<0.05]. A value of Nt-pro ANP > 5000 pmol/l predicted a hemodynamically significant PDA with a sensitivity of 97% and a specificity of 90%, whereas a value of BNP > 25 pmol/l had a sensitivity of 87% and a specificity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 80% and a specificity of 95%. There were significant positive correlations between these studied parameters [P<0.01]. Plasma naturiuretic peptides [Nt-pro ANP and BNP] can be used as predictors of the hemodynamic significance of PDA in preterm neonates, and their measurement may be regarded as complementary to echocardiography in the assessment of PDA shunt and institution of appropriate treatment. Nt-pro ANP is more sensitive and specific predictor than BNP

Relationship of Monocyte chemoattractant protein-1 with diabetic nephropathy in children with type-1 diabetes: effect of high dose vitamin E therapy

Monocyte chemoattractant protein-1 [MCP-1] is a specific chemokine that activates monocytes from the circulation to the inflammatory sites. In diabetic nephropathy, similar to other glomerulonephropathies, infiltration and activation of monocytes / macrophages in the glomeruli have been implicated in the development of glomerular injury. The aim of this study was to examine a possible relationship of the MCP-1 with the development of diabetic nephropathy in children with type-1 diabetes before and after treatment with high dose of vitamin E for eight weeks. This study was carried out on thirty diabetic children, group 1; fifteen children with type 1 diabetes mellitus with persistent microalbuminuria, and group 2; fifteen children without microalbuminuria. Fifteen healthy children served as control group. Albumin excretion rate [AER] and glycosylated hemoglobin [HbA[1C]] were measured, also plasma MCP-1 levels were measured by ELISA before and after treatment with vitamin E for eight weeks. The results proved that plasma levels of MCP-1 were significantly higher in children with diabetic nephropathy than diabetic children without nephropathy and the control group [P<0.05]. There was strong positive correlation between HbA[1C] level and AER and MCP-1 [P<0.0001]. After treatment with vitamin E, there was a significant decrease in the MCP-1 plasma levels in diabetic children with nephropathy. This study suggests that facilitated MCP-1 production by the mesangial cells in diabetic children contributes to the initiation and progression of diabetic nephropathy. High-dose vitamin E supplementation may provide an additional benefit, as adjuvant therapy to insulin treatment, in reducing the risks for the development of diabetic nephropathy

Serum terminal complement complex as a prognostic predictor in children with congestive heart failure

The activation of the complement system in pediatric patients with congestive heart failure [CHF] still remains unclear. The objective of this study was to measure the serum levels of terminal complement complex [C5b-9] to determine its predictive value for the prognosis in children with CHF, and to correlate these levels with clinical and echocardiographic assessment of heart failure. Forty cardiac patients with CHF, with a mean age of 5.2 years, were enrolled in the study. According to Ross classification of CHF, they were classified as: Ross class II [12 patients], class III [13 patients], and class IV [15 patients]. Twenty healthy children served as a control group. Serum C5b-9 was assessed with Enzyme lmmunoassay and serum tumor necrosis factor- alpha [TNF- alpha] was measured using ELISA kits. Echocardiographic assessment of left ventricular systolic and diastolic functions was performed. Clinical outcomes were determined at follow-up period of 6months [death or major adverse cardiac events]. The results showed that serum C5b-9 [and also serum TNF- alpha] were significantly higher in patients with CHF as compared to controls [P<0.001] and increased with the severity of the disease, with the highest levels in Ross class IV children and in patients with adverse clinical outcomes by 6 months [P<0.001]. there were significant positive correlations between Ross class of CHF and serum c5b-9 levels, and significant negative correlations between echocardiographic parameters of ventricular function and C5b-9 levels [P<0.001]. Serum C5b-9 [the terminal complement complex] is significantly elevated in children with CHF, increasing with the severity of the disease, and it is a prognostic predictor of adverse clinical outcome. Complement may be a novel target for therapeutic intervention with specific complement inhibitors in patients with CHF

Cardiac troponin-T as a diagnostic marker in children with rheumatic carditis

Rheumatic carditis is the most serious major manifestation of acute rheumatic fever in children. Cardiac Troponin-T [cTnT] is established as a new specific marker of myocardial damage or injury. The present work was carried out to study the value of cTnT as a diagnostic marker of myocardial injury in children with rheumatic carditis, and to compare it to established parameters of myocardial injury such as creatine kinase [CK] and its MB isoenzyme. Forty-five children with acute rheumatic fever were enrolled in the study; classified into 3 groups: group [A]: 15 children with rheumatic carditis without cardiomegaly, group [B]: 15 children with rheumatic carditis and cardiomegaly and group [C]: 15 children with other rheumatic presentations. Fifteen normal healthy children were enrolled as a control group. All children included in the study were subjected to diagnostic laboratory and radiological investigations, including serum total CK, CK-MB isoenzyme% [using electrophoresis] and cTnT [by immunoassay test]. Our results showed significant elevation of cTnT, total CK and CK-MB isoenzyme in children with rheumatic carditis [groups A and B], as compared to the control group [P < 0.05]. These values were significantly higher in group [B] children [with cardiomegaly], as compared to group [A] children [P<0.05]. Also, the ideal cut-off point for cTnT was found to be 0.1 micro g/L with a sensitivity 100%, while the sensitivity for CK-MB was 86.7% and that for total CK was 53.3%.we conclude that cardiac troponin-T [cTnT] can be used as a diagnostic marker of myocardial injury in children with rheumatic carditis, with a higher sensitivity than CK and its MB isoenzyme