Abstract
Background:
Cardiovascular compromise is increasingly recognized in preterm infants. Currently, echocardiography is the best tool to assess myocardial contractility and guide management. Elevated levels of cardiac troponin T (cTnT) and N-terminal-pro-B type natriuretic peptide (NTpBNP) are associated with poor myocardial contractility and low cardiac output in adults.
Objective:
To examine the range of cTnT and NTpBNP in preterm infants, to correlate NTpBNP and cTnT with echocardiographic markers of cardiac function and to assess the influence of antenatal and postnatal factors on these biochemical markers.
Study Design:
Plasma concentrations of cTnT and NTpBNP were measured in infants <1500 g at 12 h of age. These were correlated with simultaneous echocardiographic measures of myocardial function and output. Antenatal data, infant demographics and postnatal characteristics were prospectively recorded.
Result:
A total of 80 infant had samples taken and echocardiography performed. Their median (interquartile range) cTnT and NTpBNP values were 0.20 μg l−1 (0.11 to 0.40) and 1273 pmol l−1 (664 to 2798), respectively. There was a significant inverse correlation between cTnT and echocardiographic markers of myocardial function and stroke volume. NTpBNP significantly correlated with left atrial to aortic root ratio (LA:Ao). There was a weaker but significant negative correlation between NTpBNP and left ventricular (LV) function. The assays were not influenced by gestation, birth weight, gender or mode of delivery.
Conclusion:
cTnT and NTpBNP are correlated with echocardiographic measures of cardiac performance in preterm infants. Measurement of levels in the first hours of life may provide useful information regarding myocardial function and volume loading.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Evans N, Kluckow M . Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 74 (2): F88–F94.
Kluckow M, Seri I, Evans N . Functional echocardiography: an emerging clinical tool for the neonatologist. J Pediatr 2007; 150 (2): 125–130.
El-Khuffash A, Molloy EJ . Are B-type natriuretic peptide (BNP) and N-terminal- pro-BNP useful in neonates? Arch Dis Child Fetal Neonatal Ed 2007; 92 (4): F320–F324.
Flynn PA, da Graca RL, Auld PA, Nesin M, Kleinman CS . The use of a bedside assay for plasma B-type natriuretic peptide as a biomarker in the management of patent ductus arteriosus in premature neonates. J Pediatr 2005; 147 (1): 38–42.
Choi BM, Lee KH, Eun BL, Yoo KH, Hong YS, Son CS et al. Utility of rapid B-type natriuretic peptide assay for diagnosis of symptomatic patent ductus arteriosus in preterm infants. Pediatrics 2005; 115 (3): e255–e261.
Reynolds EW, Ellington JG, Vranicar M, Bada HS . Brain-type natriuretic peptide in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatrics 2004; 114 (5): 1297–1304.
El-Khuffash AF, Amoruso M, Culliton M, Molloy EJ . N-terminal pro-B-type natriuretic peptide as a marker of ductal haemodynamic significance in preterm infants: a prospective observational study. Arch Dis Child Fetal Neonatal Ed 2007; 92 (5): F421–F422.
Gomes AV, Potter JD, Szczesna-Cordary D . The role of troponins in muscle contraction. IUBMB Life 2002; 54 (6): 323–333.
Costa S, Zecca E, De RG, De LD, Barbato G, Pardeo M et al. Is serum troponin T a useful marker of myocardial damage in newborn infants with perinatal asphyxia? Acta Paediatr 2007; 96 (2): 181–184.
Clark SJ, Newland P, Yoxall CW, Subhedar NV . Sequential cardiac troponin T following delivery and its relationship with myocardial performance in neonates with respiratory distress syndrome. Eur J Pediatr 2006; 165 (2): 87–93.
Moss TJ . Respiratory consequences of preterm birth. Clin Exp Pharmacol Physiol 2006; 33 (3): 280–284.
Mueller T, Gegenhuber A, Poelz W, Haltmayer M . Comparison of the Biomedica NT-proBNP enzyme immunoassay and the Roche NT-proBNP chemiluminescence immunoassay: implications for the prediction of symptomatic and asymptomatic structural heart disease. Clin Chem 2003; 49 (6 Part 1): 976–979.
Osborn DA, Evans N, Kluckow M . Left ventricular contractility in extremely premature infants in the first day and response to inotropes. Pediatr Res 2007; 61 (3): 335–340.
Alverson DC, Eldridge MW, Johnson JD, Aldrich M, Angelus P, Berman Jr W . Noninvasive measurement of cardiac output in healthy preterm and term newborn infants. Am J Perinatol 1984; 1 (2): 148–151.
Lee LA, Kimball TR, Daniels SR, Khoury P, Meyer RA . Left ventricular mechanics in the preterm infant and their effect on the measurement of cardiac performance. J Pediatr 1992; 120 (1): 114–119.
El HM, Vaksmann G, Rakza T, Kongolo G, Storme L . Severity of the ductal shunt: a comparison of different markers. Arch Dis Child Fetal Neonatal Ed 2005; 90 (5): F419–F422.
Hammerer-Lercher A, Mair J, Tews G, Puschendorf B, Sommer R . N-terminal pro-B-type natriuretic peptide concentrations are markedly higher in the umbilical cord blood of newborns than in their mothers. Clin Chem 2005; 51 (5): 913–915.
Clark SJ, Newland P, Yoxall CW, Subhedar NV . Concentrations of cardiac troponin T in neonates with and without respiratory distress. Arch Dis Child Fetal Neonatal Ed 2004; 89 (4): F348–F352.
Clark SJ, Newland P, Yoxall CW, Subhedar NV . Cardiac troponin T in cord blood. Arch Dis Child Fetal Neonatal Ed 2001; 84 (1): F34–F37.
Bar-Oz B, Lev-Sagie A, Arad I, Salpeter L, Nir A . N-terminal pro-B-type natriuretic peptide concentrations in mothers just before delivery, in cord blood, and in newborns. Clin Chem 2005; 51 (5): 926–927.
Gill AB, Weindling AM . Echocardiographic assessment of cardiac function in shocked very low birthweight infants. Arch Dis Child 1993; 68 (1 Spec No): 17–21.
Clark SJ, Newland P, Yoxall CW, Subhedar NV . Sequential cardiac troponin T following delivery and its relationship with myocardial performance in neonates with respiratory distress syndrome. Eur J Pediatr 2006; 165 (2): 87–93.
Acknowledgements
We thank Dr John Murphy for his constant support.
Funding: National Maternity Hospital Research Fund.
Author information
Authors and Affiliations
Corresponding author
Additional information
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
EL-Khuffash, A., Davis, P., Walsh, K. et al. Cardiac troponin T and N-terminal-pro-B type natriuretic peptide reflect myocardial function in preterm infants. J Perinatol 28, 482–486 (2008). https://doi.org/10.1038/jp.2008.21
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2008.21
Keywords
This article is cited by
-
Exploration of potential biochemical markers for persistence of patent ductus arteriosus in preterm infants at 22–27 weeks’ gestation
Pediatric Research (2019)
-
Cardiac Troponin T in Healthy Full-Term Infants
Pediatric Cardiology (2019)
-
NTproBNP is a useful early biomarker of bronchopulmonary dysplasia in very low birth weight infants
European Journal of Pediatrics (2019)
-
Cardiac injury biomarkers in paediatric age: Are we there yet?
Heart Failure Reviews (2016)
-
Cardiac troponin I concentrations as a marker of neurodevelopmental outcome at 18 months in newborns with perinatal asphyxia
Journal of Perinatology (2014)