Study of Myocardial Dysfunction in Perinatal Asphyxia

Aims and objective: To study an incidence of myocardial dysfunction in neonates with perinatal asphyxia, to find out its correlation with severity of birth asphyxia and its outcome. Design/Methods: This prospective study was conducted among 40 term neonates admitted in NICU of Civil Hospital Ahmedabad who had suffered with perinatal asphyxia (defined by WHO), resuscitated as per NRP guidelines-2015 including both intramural and extramural admissions and who developed to hypoxic ischemic encephalopathy as defined by Levene staging. Neonates with congenital heart diseases, major CNS malformations and neonatal sepsis were excluded. Myocardial involvement was assessed by clinical evaluation of CCF, shock, respiratory distress, abnormal ECG changes and cardiac markers (CK Total, CK-MB and Troponin I) measurements. Results: Among 40 cases, 10 (25 %) neonates had moderate birth asphyxia while 30 (75 %) had severe birth asphyxia. Respiratory distress was observed in 34 (77.5 %), poor spontaneous respiration 4 (10 %), shock in 14 (35 %), CCF 19 (47.5 %) while ECG was abnormal in 30 (76.7 %). Serum levels of CPK Total, CPK- MB and Troponin I were raised in 34 (85 %), 32 (80 %) and 28 (70 %) neonates, respectively. There was a direct correlation between ECG changes and enzymatic levels which showed increasing abnormalities with increasing with severity of HIE. Conclusions: Clinical deterioration, abnormal ECG and cardiac enzymes levels due to myocardial damage found in HIE are associated with poor outcome. Early detection can help in better management and survival of these neonates. Neverthless the importance of preventing birth asphyxia itself cant be undermined, which would be a major milestone in preventing neonatal mortality.