Leyla KARADENİZ, EMİNE ASUMAN ÇOBAN, Zeynep İNCE, Ümit TÜRKOĞLU, Gülay CAN

Preeklamptik anne bebeklerinin kordon kanı kardiyak troponin T ve proteine bağlı olmayan demir düzeyleri

Amaç: Hipoksik yenidoğanlarda artmış kardiyak troponin T'nin (cTnT) kardiyak hasarın, yüksek proteine bağlı olmayan demir düzeyinin de (NPBI) artmış serbest radikal yapımı ve perinatal beyin hasarının göstergesi olduğu gösterilmiştir. Bu çalışmada, preeklamptik anne bebeklerinin kordon kanı serum cTnT ve plazma NPBI düzeyleri ölçüldü, sonuçlarla klinik bulgular arasındaki ilişkiyi belirlemek amaçlandı. Yöntem: Çalışma, 50'si preeklamptik (çalışma grubu), 50'si preklamptik olmayan sağlıklı annelerden (kontrol grubu) doğan 100 yenidoğanda yapıldı. Kordon kanında serum cTnT, plazma NPBI düzeyleri ve kan gazı bakıldı. Kardiyak troponin T için > 0.03 nglmL değeri yüksek olarak kabul edildi. Bulgular: Çalışma ve kontrol grubunun ortalama gestasyon yaşları 36.1 ±3.5 hafta ve 38.1 ±1.9 hafta (p

Anahtar Kelimeler:

Demir, Preeklampsi, Troponin, Fetal kan, Süt çocuğu, yenidoğan

Cord blood cardiac troponin T and non protein bound iron levels in newborns of pre-eclamtic mothers

Objective: In hypoxic newborns, cardiac troponin T (cTnT) was shown to be an indicator of cardiac damage and high levels of non protein bound iron (NPBI) an indicator of increased free radical production and perinatal brain damage. The aim of this study was to determine cord blood serum cTnT and plasma NPBI levels in neonates of pre-eclamptic mothers and to assess their relevance to clinical characteristics. Method: The study included 100 neonates, of which 50 babies are born to pre-eclamptic mothers (study group) and 50 babies to non pre-eclamptic healthy mothers (control group). Serum cTnT, plasma NPBI and blood gas were measured in cord blood. Serum cTnT levels > 0.03 nglmL was accepted as high. Results: The mean gestational age in the study and control groups were 36.1±3.5 weeks and 38.1+1.9 weeks (p<0.01), mean birth weights were 2.456+945 g and 3.059+493 g (p<0.01). The number of neonates with serum cTnT levels > 0.03 nglmL was higher in the study group (48 % vs 24 %, p<0.05). There was no relation between high serum cTnT levels and clinical characteristics. Mean plasma NPBI level was lower in the study group (2.02±1.47 pimol/L vs 2.98±1.44 pimollL,p<0.01). Serum cTnT and plasma NPBI levels of term and preterm babies were not significantly different. Conclusion: Increased levels of serum cTnT may be the result of cardiac damage in babies of pre-eclamptic mothers with chronic uteroplacental deficiency. However, plasma NPBI levels were not high as expected. It may be speculated, that fetal cerebral protective mechanisms may prevent cerebral damage in chronic hypoxia and high plasma NPBI levels may be an indicator of acute hypoxic conditions.

Keywords:

Iron, Pre-Eclampsia, Troponin, Fetal Blood, Infant, Newborn,

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1. Daga SR, Prabhu PG, Chandrashekhar L, Lokhande MP. Myocardial ischaemia following birth asphyxia. Indian Pediatr 1983; 20:567-71.
2. Cabal LA, Devaskar U, Siassi B, Hodgman JE, Emmanouilides G. Cardiogenic shock associated with perinatal asphyxia in preterm infants. J Pediatr 1990; 96:705-10.
3. Gerhardt W, Katus HA, Ravkilde J, Hamm CW. S-troponin-T as a marker of ischemic myocardial injury. Clin Chem 1992; 38:1194-5.
4. Dorrepaal CA, Berger HM, Benders MJ, van Zoeren-Grobben D, Van de Bor M, Van Bel F. Nonprotein-bound iron in postasphyxial reperfusion injury of the newborn. Pediatrics 1996; 98:883-9.
5. Buonocore G, Perrone S, Carlini M, Bagnoli F, Gatti MG, Paffetti P, et al. Non protein bound iron plasma levels in critically ill newborns (abstract). Biol Neonate 2001; 80:93-4.
6. Buonocore G, Perrone S, Longini M, Paffetti P, Vezzosi P, Gatti MG, et al. Non protein bound iron as early predictive marker of neonatal brain damage. Brain 2003; 126:1224-30.
7. Narin N, Çetin N, Kılıç H, Başbuğ M, Narin F, Kafalı M, et al. Diagnostic value of troponin T in neonates of mild preeclamptic mothers. Biol Neonate 1999; 75:137-42.
8. The Joint European Society of Cardiology / American Collage of Cardiology Committee. Myocardial infarction redefineda consensus document of The Joint European Society of Cardiology / American Collage of Cardiology Committee for the redefinition of myocardial infarction. JACC 2000; 36:959-69.
9. Gutteridge JM, Rowley DA, Halliwell B. Superoxide-dependent formation of hydroxyl radicals in the presence of iron salts. Detection of 'free' iron in biological systems by using bleomycin-dependent degradation of DNA. Biochem J 1981; 199:263-5.
10. Möller JC, Thielsen B, Schaible TF, Reiss I, Kohl M, Welp T, et al. Value of myocardial hypoxia markers (creatine kinase and its MB-fraction, troponin-T, QT-intervals) and serum creatinine for the retrospective diagnosis of perinatal asphyxia. Biol Neonate 1998; 73:367-74.
11. Shelton SD, Fouse BL, Holleman CM, Sedor FA, Herbert WN. Cardiac troponin T levels in umbilical cord blood.Am J Obstet Gynecol 1999; 181:1259-62.
12. Makikallio K, Vuolteenaho O, Jouppila P, Rasanen J. Association of severe placental insufficiency and systemic venous pressure rise in the fetus with increased neonatal cardiactroponin T levels. Am J Obstet Gynecol 2000; 183:726-31.
13. Clark SJ, Newland P, Yoxall CW, Subhedar NV. Cardiactroponin T in cord blood. Arch Dis Child Fetal Neonatal Ed 2001; 84:34-7.
14. 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; 92:1463-7.
15. Panteghini M, Agnoletti G, Pagani F, Spandrio M. Cardiac Troponin T in serum as a marker for myocardial injury in newborns. Clin Chem 1997; 43:1455-7.
16. Trevisanuto D, Zaninotto M, Altinier S, Plebani M, Zanardo V. High serum cardiac troponin T concentrations in preterm infants with respiratory distress syndrome. Acta Paediatr 2000; 89:1134-6.
17. 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; 89:348-52.
18. Adamcova M, Kokstein Z, Palicka V, Vavrova J, Podholova M, Kostal M. Cardiac troponin T in neonates after acute and long-term tocolysis. Biol Neonate 2000; 78:288-92.
19. Perrone S, Bracci R, Buonocore G. New biomarkers of fetal-neonatal hypoxic stres. Acta Paediatr Suppl 2002; 91:135-8.
20. Yu T, Kui LQ, Ming QZ. Effect of asphyxia on non-protein-bound iron and lipid peroxidation in newborn infants. Dev Med Child Neurol 2003; 45:24-7.