Cardiac Troponin-I Level at 24 hours of Age in Stable Newborn Infants Born at ≥35 Weeks of Gestation

Abstract

Objective

Cardiac troponin-I is a known biomarker of myocardial injury in adults and children but its diagnostic utility is unclear in newborns.

This study aimed to establish normative data for troponin-I in stable newborns and assess any variation due to maternal diabetes status, mode of delivery, and Apgar scores.

Study Design

Prospective, observational study of stable newborn ≥35 weeks gestation admitted to a well-baby nursery at a single institution. Infants with respiratory distress, congenital infections, malformations, or syndromes were excluded. Troponin-I values were obtained by a validated point-of-care capillary blood sample at 24 hours of age.

Results

A total of 132 patients were included for analysis. Thirteen infants were born to mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy and analyzed as a subgroup, with the remaining 119 infants comprising the base cohort to establish baseline normative troponin-I levels in stable newborn infants. The mean (standard deviation) troponin-I level of infants in the base cohort group was 0.019 ± 0.018 ng/mL and in infants born with maternal SARS-CoV-2 infection during pregnancy troponin-I level was 0.081 ± 0.1 ng/mL (p < 0.001). In infants of the base cohort, there was no significant difference in troponin-I levels between diabetic versus nondiabetic mothers, vaginal birth versus cesarean section, and 5-minute Apgar score of <7 versus ≥7.

Conclusion

Cardiac troponin-I level in healthy term newborns was 0.019 ± 0.018 ng/mL, which conforms to healthy children and adult lab values. There was no statistically significant difference in troponin-I levels in infants of maternal diabetes or normal glucose status, mode of delivery, cesarean versus vaginal, or 5-minute Apgar score of <7 or ≥7. Troponin-I levels in asymptomatic neonates born to mothers with a history of SARS-CoV-2 during pregnancy demonstrated an elevation when compared to the baseline group of infants.

Key Points

• Troponin‐I level, biomarker of myocardial injury, in newborns not requiring delivery‐room.

• Resuscitation is comparable to normal pediatric & adult population independent of mode of delivery or maternal diabetes status.

Keywords

cardiac troponin-I - stable newborn infant - myocardial injury biomarker - maternal COVID

Authors' Contributions

D.C.R. obtained the consent, collected the data, and wrote the first draft of the manuscript.

C.P. and L.W. ran the point-of-care tests, collected the data, and reviewed the manuscript.

J.C. analyzed the data, reviewed, and revised the manuscript.

J.R. provided the cardiology consultation and follow-up, and reviewed and revised the manuscript.

U.K.M. conceptualized the study, obtained consent, analyzed the results, and revised the manuscript.

Publication History

Received: 08 May 2024

Accepted: 23 October 2024

Article published online:
25 November 2024

• References

• 1 Yoldaş T, Örün UA. What is the significance of elevated troponin I in children and adolescents? A diagnostic approach. Pediatr Cardiol 2019; 40 (08) 1638-1644
• 2 Garg P, Morris P, Fazlanie AL. et al. Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin. Intern Emerg Med 2017; 12 (02) 147-155
• 3 Ottinger D, Nash P. Troponin. Neonatal Netw 2013; 32 (05) 365-368
• 4 Katrukha IA. Human cardiac troponin complex. Structure and functions. Biochemistry (Mosc) 2013; 78 (13) 1447-1465
• 5 Karlén J, Karlsson M, Eliasson H, Bonamy AE, Halvorsen CP. Cardiac Troponin T in healthy full-term infants. Pediatr Cardiol 2019; 40 (08) 1645-1654
• 6 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 (04) F348-F352
• 7 Iacovidou N, Boutsikou M, Gourgiotis D. et al. Perinatal changes of cardiac troponin-I in normal and intrauterine growth-restricted pregnancies. Mediators Inflamm 2007; 2007: 53921
• 8 Bader D, Kugelman A, Lanir A, Tamir A, Mula E, Riskin A. Cardiac troponin I serum concentrations in newborns: a study and review of the literature. Clin Chim Acta 2006; 371 (1-2): 61-65
• 9 Trevisanuto D, Pitton M, Altinier S, Zaninotto M, Plebani M, Zanardo V. Cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in umbilical cord blood of healthy term neonates. Acta Paediatr 2003; 92 (12) 1463-1467
• 10 Trevisanuto D, Doglioni N, Altinier S, Zaninotto M, Plebani M, Zanardo V. Cardiac troponin I at birth is of fetal-neonatal origin. Arch Dis Child Fetal Neonatal Ed 2009; 94 (06) F464-F466
• 11 Shastri AT, Samarasekara S, Muniraman H, Clarke P. Cardiac troponin I concentrations in neonates with hypoxic-ischaemic encephalopathy. Acta Paediatr 2012; 101 (01) 26-29
• 12 Montaldo P, Rosso R, Chello G, Giliberti P. Cardiac troponin I concentrations as a marker of neurodevelopmental outcome at 18 months in newborns with perinatal asphyxia. J Perinatol 2014; 34 (04) 292-295
• 13 Munshi UK, Brown MM, Tauber KA, Horgan MJ. Early troponin I levels in newborns undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy and residual encephalopathy at discharge. Am J Perinatol 2022; 39 (10) 1083-1088
• 14 Agrawal J, Shah GS, Poudel P, Baral N, Agrawal A, Mishra OP. Electrocardiographic and enzymatic correlations with outcome in neonates with hypoxic-ischemic encephalopathy. Ital J Pediatr 2012; 38: 33
• 15 Türker G, Babaoğlu K, Gökalp AS, Sarper N, Zengin E, Arisoy AE. Cord blood cardiac troponin I as an early predictor of short-term outcome in perinatal hypoxia. Biol Neonate 2004; 86 (02) 131-137
• 16 Kilbride H, Way GL, Merenstein GB, Winfield JM. Myocardial infarction in the neonate with normal heart and coronary arteries. Am J Dis Child 1980; 134 (08) 759-762
• 17 Renko M, Leskinen M, Kontiokari T, Tapiainen T, Hedberg P, Uhari M. Cardiac troponin-I as a screening tool for myocarditis in children hospitalized for viral infection. Acta Paediatr 2010; 99 (02) 283-285
• 18 Farias ECF, Justino MCA, Mello MLFMF. Multisystem inflammatory syndrome in a child associated with coronavirus disease 19 in the Brazilian Amazon: fatal outcome in an infant. Rev Paul Pediatr 2020; 38: e2020165
• 19 Plunkett BA, Weiner SJ, Saade GR. et al. Maternal diabetes and intrapartum fetal electrocardiogram. Am J Perinatol 2024; 41 (S 01): e14-e21
• 20 Oran B, Cam L, Başpinar O. et al. Cardiac troponin-I in the serum of infants of diabetic mothers. Cardiol Young 2003; 13 (03) 248-252
• 21 Korraa A, Ezzat MH, Bastawy M, Aly H, El-Mazary AA, Abd El-Aziz L. Cardiac troponin I levels and its relation to echocardiographic findings in infants of diabetic mothers. Ital J Pediatr 2012; 38: 39
• 22 Rakesh K, Vishnu Bhat B, Adhisivam B, Ajith P. Effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia - a randomized controlled trial. J Matern Fetal Neonatal Med 2018; 31 (18) 2418-2423
• 23 Lee IC, Yu CS, Wong SH, Lue KH, Troponin I. Troponin I levels in neonatal hypoxic-ischemic encephalopathy are related to cardiopulmonary comorbidity and neurodevelopmental outcomes. J Clin Med 2021; 10 (17) 4010
• 24 Xu ZE, Mbugi J, Hu Y, Yue W, Hua Z, Wei H. Serum troponin I: a potential biomarker of hypoxic-ischemic encephalopathy in term newborns. Childs Nerv Syst 2022; 38 (02) 295-301
• 25 Liu X, Chakkarapani E, Stone J, Thoresen M. Effect of cardiac compressions and hypothermia treatment on cardiac troponin I in newborns with perinatal asphyxia. Resuscitation 2013; 84 (11) 1562-1567
• 26 Vijlbrief DC, Benders MJ, Kemperman H, van Bel F, de Vries WB. Cardiac biomarkers as indicators of hemodynamic adaptation during postasphyxial hypothermia treatment. Neonatology 2012; 102 (04) 243-248
• 27 Douglas-Escobar M, Weiss MD. Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr 2015; 169 (04) 397-403
• 28 Yıldız EP, Ekici B, Tatlı B. Neonatal hypoxic ischemic encephalopathy: an update on disease pathogenesis and treatment. Expert Rev Neurother 2017; 17 (05) 449-459
• 29 Bonifacio SL, Hutson S. The term newborn: evaluation for hypoxic-ischemic encephalopathy. Clin Perinatol 2021; 48 (03) 681-695
• 30 Jiang L, Li Y, Zhang Z, Lin L, Liu X. Use of high-sensitivity cardiac troponin I levels for early diagnosis of myocardial injury after neonatal asphyxia. J Int Med Res 2019; 47 (07) 3234-3242
• 31 Schlapbach LJ, Ersch J, Balmer C. et al. Enteroviral myocarditis in neonates. J Paediatr Child Health 2013; 49 (09) E451-E454
• 32 Chuang YY, Huang YC. Enteroviral infection in neonates. J Microbiol Immunol Infect 2019; 52 (06) 851-857
• 33 Briana DD, Papaevangelou V, Syridou G. et al. Clinical symptoms associated with laboratory findings and placental histopathology in full-term, non-infected neonates born to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive mothers. J Matern Fetal Neonatal Med 2022; 35 (25) 8706-8709
• 34 Lipshultz SE, Simbre II VC, Hart S. et al. Frequency of elevations in markers of cardiomyocyte damage in otherwise healthy newborns. Am J Cardiol 2008; 102 (06) 761-766
• 35 Mondal T, Ryan PM, Gupta K. et al. Cord-blood high-sensitivity troponin-i reference interval and association with early neonatal outcomes. Am J Perinatol 2022; 29 (14) 1548-1554
• 36 Turrini I, Sorbi F, Ghizzoni V. et al. Severe fetal distress and placental damage might be associated with high troponin I (cTnI) levels in mothers. Am J Case Rep 2018; 19: 194-198