RU2124207C1 - Method for evaluating myocardial lesion severity degree in newborns - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves measuring troponin-T contents level during the first days of baby life. Its growth by 3.0 to 8.0 ng/l being detected when compared to healthy children reference values, moderate myocardial lesion is to be diagnosed. The troponin-T contents level growth of 13.0 to 16.0 being observed, myocardial lesion due to hypoxic ischemia cardiopathy and congenital heart disease is diagnosed in the newborns. EFFECT: enhanced accuracy and cardiac specificity of the method.

Description

 The invention relates to medicine, namely to perinatal cardiology, and can be used, in particular, for the diagnosis of myocardial lesions in newborns.

 From the practice of medicine currently known methods for the diagnosis of various myocardial lesions, consisting in immunological and biochemical blood tests / see, for example, author. St. N 839492, bull. N 23, 1981, p. 9 "Method for the diagnosis of myocardial diseases" by S.A. Pavlishchuk et al., Ed. St. N 1204214, bull. N 2, 1986, p. 17 "Method for the differential diagnosis of organic and inorganic myocardial diseases" by T.I. Grekova.

The disadvantages of the known methods are:
- the complexity for practical use;
- the inability to reliably determine the early signs of myocardial damage in newborns undergoing chronic hypoxia, suffering from lesions of the central nervous system / central nervous system / hypoxic genesis, as well as in the presence of congenital heart defects, manifested by heart failure from the first days of a child's life;
- the implementation of these methods involves the use of special equipment, expensive reagents and test systems and special conditions for their implementation.

 The closest way to the proposed is author. St. N 1770907, bull. N 39, 1992, p. 159, "Method for the differential diagnosis of myocardial lesions in young children" by N.S. Cherkasov, consisting in the fact that on the first or second day from the onset of the disease and after 7-14 days, the content of sensitized lymphocytes and antibodies to myoglobin is determined and with an increase in the first indicator by 5% or more, and the second - 2 times or more relative to the original level diagnosed with acute myocardial dystrophy.

However, the known method has the following disadvantages:
- the method is not accurate enough, since an increase in the level of myoglobin in blood serum can contribute not only to damage to the heart, but also to skeletal muscle;
- the method has an insufficiently wide diagnostic period, since myoglobin appears early / after 2-3 hours / and quickly disappears from the bloodstream / 8-9 hours /;
- the method is not sufficiently informative in the early days of the disease, since the level of antibodies to myoglobin during this period remains low.

 The aim of the present invention is to improve the accuracy of the method of sketching the severity of myocardial damage in hypoxic-ischemic cardiopathies and congenital heart defects in newborns.

 The goal of the invention is achieved by examining the level of troponin-T in the first days of life and with an increase in the level of troponin-T from 3.0 to 8.0 ng / ml relative to that in healthy children, moderate myocardial damage is diagnosed, and with an increase in the level of troponin -T from 13.0 to 16.0 ng / ml diagnose severe myocardial damage with hypoxic-ischemic cardiopathy and congenital heart disease in newborns.

 Troponin-T is one of the myocardial contrycal proteins. Its penetration into the bloodstream indicates a different degree of damage to cardiomyocytes, for example, with severe ischemia or cell necrosis. Other myocardial proteins and enzymes used in the diagnosis of myocardial damage, such as myoglobin, creatine phosphokinase and its isoenzymes, do not have a sufficiently high diagnostic specificity and sensitivity. It is known that the activity of creatine phosphokinase and its isoenzymes can increase or damage to the central nervous system, cardiac and skeletal muscles. High serum myoglobin levels can be determined both with myocardial damage and with skeletal muscle damage. An increase in serum creatine phosphokinase activity is observed 10 hours after myocardial damage, and the maximum concentration is observed after 19 hours, after which it begins to decline. An increase in serum myoglobin level can be determined 2-3 hours after myocardial damage, the maximum concentration is noted after 8-9 hours, after which it is rapidly excreted by the kidneys. The level of troponin-T begins to rise after 3.5-10 hours after myocardial damage and remains high for 1-3 weeks.

 Thus, the advantage of myocardial troponin-T compared with other myocardial proteins and enzymes is a higher diagnostic specificity and sensitivity, as well as a wider diagnostic period. In this case, the use of a test system for myocardial troponin-T provides high specificity.

 The positive effect of the proposed method is achieved by increasing the accuracy of diagnosis due to the cardiospecificity of this test and a wide diagnostic period, as well as the ability to assess the severity of myocardial damage, in the ease of research and accessibility for wide practical use. The accuracy of the proposed method is 96%.

 The proposed method was successfully tested in the departments of the City Children's Clinical Hospital for Newborns N 1 in Astrakhan from August 1996 to March 1997 on 34 newborns with hypoxic-ischemic cardiopathy and congenital heart defects, as well as 10 conditionally healthy children. Below are the results of testing.

 Example N 1. Child X. / medical history N 2026 / was admitted to the hospital at the age of 10 days with a diagnosis of acute respiratory viral infection, cerebrovascular accident of the first degree, syndrome of increased neuro-reflex irritability, hypoxic-ischemic cardiopathy.

 The second pregnancy, the first ended in a miscarriage, for 12 years infertility. The present proceeded against the background of anemia, chronic pyelonephritis, the threat of interruption. Childbirth by cesarean section due to weak labor. Birth weight 3740.0 g, length 56 cm, head circumference 35 cm, Apgar score 7/7 points. By the end of the first day, neurological symptoms appeared in the form of a syndrome of increased neuro-reflex excitability: increased spontaneous motor activity, revitalization of unconditional congenital reflexes, muscle dystonia, tremor of the limbs and chin. On the fourth day of life, at the top of the heart, a soft systolic murmur began to be heard.

 He was admitted to the hospital in a moderate state, with a clinic of hypoxic damage to the central nervous system, hyperemia in the pharynx, obstructed nasal breathing, heart murmur.

 On the ECG - moderate sinus arrhythmia / 182-184 beats. in min./ The electric axis of the heart is deflected to the right. Incomplete blockade of the right bundle branch block. Increased systolic rate.

 Echocardioscopy - myocardial contractility is not changed. Cavities of the heart are not enlarged. No defects detected. The valve apparatus is intact.

 Serum creatine phosphokinase - 0.33 μkat / l.

 The given clinical data and the results of laboratory and instrumental methods of research do not provide an opportunity to accurately assess the severity of myocardial damage.

 To determine troponin-T, an enzyme-immune test system from Boehriger Manheiam is used. Upon receipt, a newborn takes blood from a vein in an amount of 1.5-2.0 ml, is centrifuged at 4-6 thousand rpm for 15 minutes, the separated serum is sucked off.

 The study is carried out in special plastic test tubes coated on the inside with a layer of streptovidin. Streptovidin has the ability to bind biotin antibodies and antigens.

 0.2 ml of standard, control and serum are dug into prepared tubes. Then, not earlier than after 30 minutes, the incubation solution is added. Incubation is carried out for 60 minutes. After that, the contents of the tubes are sucked off and poured off, and the tubes are immediately rinsed with an enzyme test with a washing solution twice. Then, a substrate-chromogen solution is dug into tubes and kept for 30 minutes, without shaking and avoiding direct sunlight. After that, the contents of the tubes are thoroughly mixed and poured to a 1.0 cm cuvette. Next, a measurement is made on a photoelectric calorimeter / wavelength 420 nm / against a substrate-chromogen solution.

 Based on the measurement results, a graph is constructed: the concentrations of standard solutions are plotted on the X axis, and the average absorption values on the Y axis. A calibration curve is constructed, on which the average absorption values of the studied sera are noted. Next, the troponin-T concentration, measured in ng / ml, is determined along the X axis.

 The serum troponin-T content was 3.0 ng / ml, which indicates moderate myocardial damage. In this case, a newborn can predict a favorable course of hypoxic-ischemic cardiopathy. Observation of the child in dynamics for 4 weeks, the absence of clinical and laboratory indicators of myocardial damage confirm the favorable course of hypoxic-ischemic cardiopathy.

 Example N 2. Child I. / medical history N 328 / was admitted to the hospital at the age of 6 days with a diagnosis of acute respiratory viral infection, umbilical vein phlebitis, cerebrovascular accident of the second degree, oppression syndrome, acute period, conjugation jaundice, congenital heart disease / CHD /, circulatory failure 0.

 The first pregnancy was uneventful. Births urgent, earlier amniotic fluid outflow, defect of the placenta, a single tight tight cord entanglement around the fetal neck. Birth weight 3200 g, length 51 cm, Apgar score 6/7 points.

 Condition upon receipt of moderate severity. Sluggish, spontaneous activity is reduced, hyporeflexia, lack of exercise, general muscle hypotension. The skin is moderately icteric. The pharynx is hyperemic, serous discharge from the eyes. The umbilical vein is palpated. In the lungs, breathing is weak, no wheezing. B.p.d. 40 per minute. Heart sounds are muffled, systolic murmur in the second and third intercostal space to the left of the sternum of medium intensity. Tachycardia up to 1650170 beats. per minute. The liver is 2 cm below the edge of the costal arch.

 On the ECG - negative tachycardia / 170-180 beats. in a minute/. The electrical axis of the heart is deflected to the right.

 Echocardioscopy - increased contractile function of the myocardium. The heart chambers are not enlarged. The valve apparatus is intact. The atrial septal defect in the oval window is 2 mm.

 Serum creatine phosphokinase - 0.33 μkat / l.

 The given clinical data and the results of laboratory-instrumental research methods do not allow to accurately determine the severity of myocardial damage.

 Upon admission from this patient, blood is taken from a vein and, as in example 1, studies are carried out. The troponin-T content was 3.0 ng / ml, indicating a moderate myocardial damage. Against the background of metabolic therapy, the noise intensity decreased, hemodynamic disturbances were not observed. After 3 weeks, the child was discharged from the hospital.

 Example N 3. Child N. / medical history N 509 / was admitted to the hospital at the age of one day with a diagnosis of chronic fetal hypoxia, cerebrovascular accident of the second degree, depression syndrome, acute period, hypospadias, cut wound of the scrotum, intrauterine growth retardation by hypotrophic type, hypoxic-ischemic cardiopathy.

 The fourth pregnancy, proceeded against the background of GO gestosis, pyelonephritis, neurocirculatory dystonia, second degree obesity. Previous pregnancies ended in miscarriages. Real deliveries are the first urgent, by cesarean section, in the buttock presentation, with a tight cord around the neck of the fetus. Birth weight is 2880 g, height is 50 cm. Head circumference is 36 cm, Apgar score is 4/6 points. The condition from birth is serious, signs of immaturity, a clinic of a hypoxic lesion of the central nervous system in the form of a syndrome of depression, hypospadias, a cut wound of the scrotum. He was transferred to the surgical department, where the wound was sutured, and then to the hospital for newborns. From the fourth day, a heart murmur began to be heard, a tendency to tachycardia was noted.

 On the ECG - pronounced sinus tachyarrhythmia / 176-120 beats per minute /. Incomplete blockade of the right bundle branch block. Systolic indicator is slightly increased.

 Echocardioscopy is a suspected ventricular septal defect. Easy dilatation of the right atrium.

 Doppler echocardiography - heart chambers are not changed. Valve apparatus without features. No turbulent flows were detected.

 Serum creatine phosphokinase - 0.132 mkkat / l.

 The given clinical data and the results of laboratory and instrumental methods of research do not provide an opportunity to accurately assess the severity of myocardial damage.

 Upon admission from this patient, blood is taken from a vein and, as described in Example No. 1, studies are carried out. The serum troponin-T content was 8.0 ng / ml, indicating a moderate myocardial damage. In this case, a newborn can predict a favorable course of hypoxic-ischemic cardiopathy. Observation of the dynamics and follow-up history of the child after 4-6 weeks, the absence of clinical and laboratory parameters of the damaged myocardium confirm the favorable course of hypoxic-ischemic cardiopathy.

 Example No. 4. Child Ch. / Medical history N 1753 / was admitted to the hospital at the age of 10 days with a diagnosis of congenital heart disease, circulatory failure of the first degree.

 The first pregnancy proceeded against the background of acute respiratory viral infection in the first half. First birth urgent. Birth weight 3900 g, length 54 cm, Apgar score 8/8 points. Condition upon receipt of moderate severity. The child is active, the scream is loud, the physiological reflexes of the newborn are caused, muscle tone within the physiological flexion. The skin is pink, weak cyanosis when screaming in the nasolabial triangle. There are no wheezing in the lungs. Tachypnea up to 60-65 d.d. per minute. Auscultation of the heart region revealed an increase in the first tone in the projection of the tricuspid valve, splitting of the second tone over the pulmonary artery, medium intensity systolic murmur in the second and third intercostal space on the left near the sternum. Tachycardia up to 165 beats per minute. The liver is 2.5 cm below the edge of the costal arch.

 On the ECG - severe sinus arrhythmia, with a tendency to tachycardia. The expressed rightogram. Overload of the right atrium.

 Echocardioscopy - myocardial contractility is not changed. The valve apparatus is intact. Defects are not located.

 Doppler echocardiography - hypertrophy with an increase in the cavity of the right ventricle and the right atrium. Turbulent systolic flow under the tricuspid valve. Conclusion: signs of congenital heart disease, atrial septal defect - 3 mm.

 Serum creatine phosphokinase - 0.1 mkkat / l.

 The given clinical data and the results of laboratory and instrumental research methods do not allow to accurately determine the severity of myocardial damage.

 In the study, the patient is taken blood from a vein and, as in example No. 1, studies are carried out. The troponin-T content was 8.0 ng / ml, indicating a moderate myocardial damage. Observation of the patient in dynamics confirmed the presence of moderate myocardial damage. Against the background of cardiac glycoside therapy, signs of circulatory failure stopped and after 14 days the child was discharged from the hospital.

 Example No. 5. Child K. / medical history N 2138 / at the age of 11 days was transferred from the maternity hospital to a hospital with a diagnosis of chronic fetal hypoxia, cephalohematoma of the left parietal bone, cerebrovascular accident of the second degree, hypertensive hydrocephalic syndrome, acute period, subependymal pseudocyst , hypoxic-ischemic cardiopathy.

 The first pregnancy proceeded against the background of anemia. Childbirth urgent, childbirth amniotomy. Birth weight 3150 g, head circumference 34 cm, Apgar score 6/7 points. At the end of the first day, a deterioration was noted due to the appearance of hemorrhagic syndrome / skin hemorrhages, cephalohematoma, melena /, neurological symptoms. Upon admission to the hospital, a moderate condition. Kefalogematoma, manifestations of hypertension-hydrocephalic syndrome / opening of the sagittal suture by 0.8 cm, enlargement of the large fontanel 3.0 by 3.0 cm, Gref’s symptom, inconsistent horizontal nystagmus, muscular dystonia are preserved. Heart sounds are muffled, tender systolic murmur at all points. Weakened breathing. The liver is 2 cm below the edge of the costal arch.

 On FCG - at all points of an unstable systolic murmur, it is not connected with points of the heart.

 On the ECG - mild sinus arrhythmia. The electrical axis of the heart is deflected to the right. Incomplete blockade of the right bundle branch block.

 Echocardioscopy - increased contractile function of the myocardium. A slight increase in the cavities of the right ventricle and the right atrium. Valve apparatus without features. Defects are not located.

 Neurosonography is a subependymal pseudocyst. Slight expansion of the anterior horns of the lateral ventricles.

 Radiological - the pulmonary fields are transparent, the vascular pattern is not changed, the shadow of the heart is of normal size and configuration.

 Serum creatine phosphokinase - 0.264 mkkat / l.

 The data of clinical and laboratory-instrumental methods of research do not provide an opportunity to reliably assess the severity of myocardial damage.

 Upon admission from this patient, blood is taken from a vein and, as described in example 1, studies are carried out. The serum troponin-T content was 13 ng / ml, which indicates severe myocardial damage. Dynamic monitoring of the child, the long-term preservation of the clinical signs of myocardial damage, the data of laboratory and instrumental methods in the follow-up data confirm the severe course of hypoxic-ischemic cardiology.

 Example No. 6. Child C. / medical history N 645 / was admitted to the hospital at the age of 9 days with a diagnosis of acute respiratory viral infection, congenital heart disease, circulatory failure 2A degree, cerebrovascular accident of the second degree, hypertensive hydrocephalic syndrome, acute period , intrauterine growth retardation by hypotrophic type.

 Second pregnancy, proceeded against the background of anemia. Second birth urgent. Birth weight 2800 g, length 52 cm, Apgar score 7/8 points. From birth, neurological symptoms: a discrepancy of the sagittal suture by 0.7 cm, Gref’s symptom, inconstant horizontal nystagmus, muscular dystonia. From the second day, a heart murmur began to be heard.

 Condition upon receipt of moderate severity. Clinical manifestations of a respiratory viral infection: hyperemia of the pharynx and conjunctiva, difficulty in nasal breathing. Signs of perinatal damage to the central nervous system in the form of hypertension-hydrocephalic syndrome. The skin is pale. There are wheezing in the lungs. Tachypnea up to 65-70 d.d. per minute. When auscultation of the heart region in the second intercostal space on the left is heard a rough systolic murmur associated with the first tone, systolic cliques at the apex and along the left edge of the sternum. Tachycardia up to 165-170 beats. per minute. The liver is 2.5 cm below the edge of the costal arch.

 On the ECG - pronounced sinus tachyarrhythmia / h.s.s. up to 180-150 per min. / The electric axis of the heart is deflected to the right. Change in the myocardium of the legal atrium. Increased activity of both ventricles.

 Echocardioscopy - the contractile function of the myocardium is not changed. Dilation of the left atrium, right ventricle. Left ventricular myocardial hypertrophy. Valvular aortic stenosis. Open oval - window - 2 mm.

 Doppler echocardiography - hypertrophy of the left ventricle and left atrium. Turbulent flow at the level of the aortic valve, pressure gradient 9.0 mm Hg

 Serum creatine phosphokinase - 0.49 mkkat / l.

 Upon admission from this patient, blood is taken from a vein and, as in example No. 1, a study is carried out. The troponin-T content was 13 ng / ml, indicating a severe myocardial damage. Observation of the patient in dynamics confirmed the presence of severe myocardial damage, clinically manifested by circulatory failure. Against the background of the therapy, the condition stabilized only at the eighth week of life.

 Example No. 7. Child S. / medical history N 1608 / was admitted to the hospital at the age of 10 days with a diagnosis of chronic fetal hypoxia, cerebrovascular accident of the second degree, depression syndrome, acute period, hypoxic-ischemic cardiopathy.

 The mother’s third pregnancy was proceeding against the background of gestosis, the threat of interruption at 31 weeks. Second urgent delivery, cesarean section for a uniformly narrowed pelvis. Birth weight is 3430 g, length 53 cm, head circumference 35 cm, Apgar score 4/7 points. From the first day of life, the condition is serious, the clinic of cerebrovascular accident in the form of depression syndrome: lethargy, physical inactivity, decreased spontaneous physical activity, general muscle hypotension, hyporeflexia, inhibition of reflexes in newborns. Weakened breathing, tachyarrhythmia, heart sounds are muffled, from the third day of life a soft systolic murmur at the apex began to be heard. The liver is 2 cm below the edge of the costal arch, elastic. The temperature did not rise.

 Upon admission to the hospital, a moderate condition. Signs of central nervous system depression, systolic murmur in the heart persist.

 On FCG - at all points of an unstable short systolic murmur, not associated with heart sounds.

 On the ECG - mild sinus arrhythmia / 176-158 beats. in minutes /. The electrical axis of the heart is deflected to the right. Incomplete blockade of the right bundle branch block.

 Echocardioscopy - increased contractile function of the myocardium. Valve apparatus without features. A slight increase in the cavity of the right ventricle and left atrium. Defects are not located.

 Neurosonography - the parenchyma is not quite homogeneous, granular. Vascular plexuses with fuzzy contours.

 Serum creatine phosphokinase - 1.32 mkkat / l.

 The given data of clinical and laboratory-instrumental research methods do not provide an opportunity to accurately assess the severity of myocardial damage.

 Upon admission, the patient is taken blood from a vein and, as in example No. 1, studies are carried out. The troponin-T content was 16 ng / ml, indicating a severe myocardial damage. When observing the child in the course of 3-4 weeks, it turned out that hypoxic-ischemic cardiopathy was difficult, with circulatory disorders, with long-lasting clinical and ECG signs of myocardial damage.

 Example No. 8. Child K. / medical history N 878 / was admitted to the hospital at the age of 10 days with a diagnosis of cerebrovascular accident of the second degree, depression syndrome, acute period. Congenital heart disease, circulatory failure 2A degree. Non-growth of soft and hard palate, bilateral splitting of the upper lip. Intrauterine growth retardation according to dysplastic type.

 Third pregnancy, proceeded against the background of early toxicosis, acute respiratory viral infection in the first half, neurocirculatory dystonia of a hypertonic type. Third birth urgent. Birth weight 2900 g, length 50 cm, Apgar score 8/9 points. The condition at admission is serious. Sluggish, spontaneous activity is reduced, general muscle hypotension, hyporeflexia. The skin is pale with a grayish tint. There are wheezing in the lungs. Tachypnea up to 72-74 d.d. per minute. During auscultation of the heart region at all points, a rough systolic murmur is determined with a maximum in the third and fourth intercostal space, as well as at the apex. Noise is drawn on the back and left axillary region. The second tone is strengthened and split in the projection of the pulmonary artery. Tachycardia up to 164-170 beats. per minute. The liver is 3 cm below the edge of the costal arch.

 On the ECG - sinus tachycardia. The electrical axis of the heart is deflected to the right. Incomplete blockade of the right branch of the bundle of His. Slight overload of the right atrium. Signs of right ventricular hypertrophy.

 Echocardioscopy is an open atrioventricular canal.

 The given clinical data and the results of laboratory-instrumental research methods do not allow to accurately determine the severity of myocardial damage.

 Upon admission from this patient, blood is taken from a vein and, as in example No. 1, a study is carried out. The troponin-T content was 16 ng / ml, indicating a severe myocardial damage. Observation of the patient in dynamics confirmed the presence of severe myocardial damage. Despite the therapy, the child's condition progressively worsened, the symptoms of heart and respiratory failure increased, and at the age of 18 days the child died.

 Example No. 9. Child C. / medical history N 2180 / was transferred from the hospital to a hospital at the age of 9 days with a diagnosis of chronic fetal hypoxia, cerebrovascular accident of the second degree, depression syndrome, acute course, intrauterine growth retardation of hypotrophic type, hypoxic- ischemic cardiopathy.

 Third pregnancy, proceeded against the background of toxicosis, the threat of interruption, diffuse stroma of the second degree. Second childbirth, in childbirth early outflow of amniotic fluid. Birth weight 3300 g, length 51 cm, head circumference 35 cm, Apgar score 6/7 points. Condition upon receipt of moderate severity. There was a clinic of perinatal damage to the central nervous system in the form of depression syndrome: lethargy, lack of exercise, decreased spontaneous physical activity, general muscle hypotension, hyporeflexia, inhibition of newborn reflexes, nystagmus. Weakened breathing, tachycardia, muffled heart sounds. The liver is 2 cm below the edge of the costal arch.

 On the ECG - sinus tachycardia. The electrical axis of the heart is deflected to the right. Incomplete blockade of the right bundle branch block.

 Echocardioscopy - the contractile function of the myocardium is moderately increased. Easy dilation of the left atrium.

 Creatine phosphokinase - 0.33 mkkat / l.

 The data of clinical and laboratory instrumental methods of research do not allow to accurately determine the severity of myocardial damage.

 Upon admission, the patient is taken blood from a vein and, as in example No. 1, studies are carried out. The serum troponin-T content was 5.0 ng / ml, which indicates moderate myocardial damage. In this case, a newborn can predict a favorable course of hypoxic-ischemic cardiology. Observation of the child in dynamics and follow-up after 4-6 weeks, the absence of clinical and laboratory indicators of myocardial damage confirm the favorable course of hypoxic-ischemic cardiopathy.

 Example No. 10. Child R. / medical history N 2243 / was admitted to the hospital at the age of 5 days with a diagnosis of chronic fetal hypoxia, cerebrovascular accident 2 degrees, inhibition syndrome, acute period, congenital heart disease, circulatory failure 0.

 The first pregnancy, proceeded against the background of anemia, the threat of interruption, OP gestosis, ureaplasmosis. Births urgent, premature discharge of amniotic fluid, weak labor, tight cord entanglement around the neck of the fetus. Birth weight 3530 g, length 53 cm, rating on Apgar scale 5/6 points. Condition upon receipt of moderate severity. The clinic of hypoxic damage to the central nervous system, systolic murmur in the heart of medium intensity in the second and third intercostal space to the left of the sternum is preserved.

 On the ECG - moderate sinus arrhythmia / 143-115 beats. in a minute/. The electrical axis of the heart is deflected to the right. Incomplete blockade of the right bundle branch block.

 Echocardioscopy - the contractile function of the myocardium is not changed. Moderate enlargement of the cavity of the right ventricle. The atrial septal defect in the oval window is 3 mm.

 Serum creatine phosphokinase - 0.165 mkkat / l.

 A study of blood serum is carried out in the same way as in the first example. The troponin-T content was 5.0 ng / ml, indicating moderate myocardial damage. Observation of the dynamics and follow-up history of the child for 4-5 weeks, the absence of clinical and laboratory signs of myocardial damage confirm the favorable course of congenital heart disease.

 Example No. 11. Child C. / medical history N 1138 / was admitted to the hospital at the age of 8 days with a diagnosis of chronic fetal hypoxia, cerebrovascular accident of the second degree, depression syndrome, hypoxic-ischemic cardiopathy, conjugation of jaundice.

 Born from the first pregnancy taking place against the background of pyelonephritis, the threat of interruption, the first urgent birth. Birth weight 3350 g, length 52 cm, head circumference 35 cm, Apgar score 6/7 points. From the first day, the condition is serious, the clinic has a hypoxic lesion of the central nervous system in the form of a depression syndrome. Weakened breathing, tachyarrhythmia. Heart sounds are muffled, from the third day of life a soft systolic murmur at the apex of the heart began to be heard. The liver is 2 cm below the edge of the costal arch. Upon admission to the hospital, a moderate condition. Signs of central nervous system depression, systolic murmur in the heart persist.

 On the ECG - moderate sinus arrhythmia / 158-130 beats. in a minute/. The electrical axis of the heart is deflected to the right. Incomplete blockade of the right bundle branch.

 On FCG - at all points there is an unstable short systolic murmur, not associated with heart sounds.

 Echocardioscopy - increased contractile function of the myocardium. A slight increase in the cavities of the right ventricle and the right atrium. Valve apparatus without features. Defects are not located.

 Serum creatine phosphokinase - 0.2 mkkat / l. Upon admission from this patient, blood is taken from a vein and, as in example No. 1, a study is carried out. The serum troponin-T content was 15 ng / ml, which indicates severe myocardial damage. When observing the child in the course of 3-4 weeks, it was established that hypoxic-ischemic cardiopathy was difficult, with circulatory disorders, with long-lasting clinical and ECG signs of myocardial damage.

 Example No. 12. Child M. / medical history N 660 / was admitted to the hospital at the age of 10 days with a diagnosis of chronic fetal hypoxia, congenital heart disease, circulatory failure of the first degree.

 The first pregnancy occurred against the background of anemia, an acute respiratory viral infection. The first delivery is urgent, born with an entanglement of the umbilical cord around the neck of the fetus, with a mass of 3750 g, a length of 52 cm, an Apgar score of 7/8 points. On the fifth day of life, a heart murmur was detected, and therefore the child was transferred to a hospital. Condition upon receipt of moderate severity. Sluggish, spontaneous motor activity is reduced, newborn reflexes are inhibited. The skin is pale, with a grayish tint, cyanosis of the nasolabial triangle. In the lungs, breathing is weakened, tachypnea up to 65-75 d.d. per minute. When auscultation of the heart region at all points is determined by gross systolic murmur, with a maximum in the third and fourth intercostal space to the left of the sternum. Tachycardia up to 170 beats. per minute. The liver is 2.5 cm below the edge of the costal arch.

 On the ECG - sinus tachycardia / 165-170 beats. in a minute/. The electrical axis of the heart is deflected to the right. Signs of myocardial changes in both atria, more left. Myocardial hypertrophy of both ventricles.

 Echocardioscopy - myocardial contractility is not impaired. The valve apparatus is intact. The atrial septal defect in the oval window is 3 mm.

 Serum creatine phosphakinase - 0.65 μkat / l.

 Upon admission from this patient, as in example No. 1, blood is taken from a vein and a study is performed. The serum troponin-T content was 15 ng / ml, which indicates severe myocardial damage. Dynamic monitoring of the patient confirmed the presence of severe myocardial damage, as evidenced by the long-lasting manifestations of heart failure and ECG signs of myocardial damage.

 Example No. 13. Child I. / medical history N 1908 / was transferred from the hospital to the hospital at the age of 7 days with a diagnosis of cerebrovascular accident of the second degree, depression syndrome, acute period, hypoxic-ischemic cardiopathy, conjugation of jaundice.

 Third pregnancy, proceeded with toxicosis in the first half, yeast colpitis. Third childbirth, in childbirth premature discharge of amniotic fluid. Birth weight 3700 g, length 52 cm, Apgar score 7/8 points. The condition at receipt of moderate severity, neurological systomatics, ictericity of the skin, systolic murmur in the heart.

 On the ECG - mild sinus arrhythmia / 154-132 beats. in a minute/. The electrical axis of the heart is deflected to the right. Change in the myocardium of the right atrium. Intraventricular conduction is partially impaired.

 Echocardioscopy - myocardial contractility is not changed. The valve apparatus is intact. Defects are not located. Serum creatine phosphokinase - 0.165 mkkat / l.

 A blood serum test is carried out as in Example 1. The troponin-T content was 1.1 ng / ml, which indicates the absence of myocardial damage. Observation of the patient in dynamics confirms the data. Against the background of metabolic therapy, the noise intensity decreased, hemodynamic disturbances were not observed. After 3 weeks in satisfactory condition, the child was discharged from the hospital.

 Example No. 14. Child K. / medical history N 2136 / was transferred from the hospital at the age of 9 days with a diagnosis of congenital heart disease, circulatory failure 0, cerebrovascular accident of the second degree, depression syndrome, acute period.

 The fourth pregnancy, proceeded against the background of the threat of interruption, toxicosis in the first half. Second birth, urgent. Birth weight 3200 g. Length 52 cm, Apgar score 7/8 points. The condition upon receipt of moderate severity, neurological symptoms persist, systolic murmur in the heart of moderate intensity in the second and third intercostal space from the sternum. On the ECG - mild sinus arrhythmia / 171-154 beats. in a minute/. Intraventricular conduction is partially impaired. Repolarization processes are disturbed.

 Echocardioscopy - increased contractile function of the myocardium. The cavities of the right ventricle and left atrium are enlarged. The atrial septal defect in the oval window is 2 mm.

 Serum creatine phosphokinase - 0.33 μkat / l.

 A blood serum test is carried out as in Example 1. The troponin-T content was 1.1 ng / ml, which indicates the absence of myocardial damage. Observation of the patient in dynamics confirmed the data. Against the background of metabolic therapy, the noise intensity decreased, hemodynamic disturbances were not observed. After 3 weeks in satisfactory condition, the child was discharged from the hospital.

 Example No. 15. / medical history N 1891 / was admitted to the hospital on the 10th day of life with a diagnosis of acute respiratory viral infection, intrauterine growth retardation by hypotrophic type, cerebrovascular accident of the first degree, syndrome of increased neuro-reflex irritability, hypoxic-ischemic cardiopathy.

 Second pregnancy, proceeded against the background of anemia. Second birth, urgent. Born with a cord around the neck, weighing 2,800 grams, 50 cm long, with an Apgar score of 6/7 points. He was admitted in a state of moderate severity with clinical manifestations of a respiratory viral infection, hypoxic damage to the central nervous system, and mild systolic murmur at the apex of the heart.

 Similar instrumental and laboratory studies were carried out. As in Example No. 1, the troponin-T content was determined, which turned out to be 12.0 ng / ml. This level of troponin-T occupies an intermediate position in the interval between its level with moderate and severe myocardial position and provides 4% inaccuracy of this method. In a specific case, when observing a child, it was further revealed that hypoxic-ischemic cardiopathy was difficult, with circulatory disorders, with long-lasting clinical and ECG signs of myocardial damage.

 Example No. 16. Child M. / medical history N 1025 / was admitted to the hospital at the age of 10 days with a diagnosis of acute respiratory viral infection, incomplete umbilical fistula, congenital heart disease, circulatory failure of the first degree.

 The second pregnancy, proceeded against the background of GO gestosis. Second labor, urgent, weak labor, labor stimulation. Birth weight 2800 g, length 52 cm, Apgar score 7/8 points. He was admitted to the hospital in a state of moderate severity, with clinical manifestations of a respiratory viral infection, serous discharge from the umbilical wound, gross systolic murmur in the heart, with a maximum sound in the third and fourth intercostal space to the left of the sternum, as well as at the apex.

 Similar instrumental and laboratory studies were carried out. As in example No. 1, the content of troponin-T in the blood serum was determined, which turned out to be 12.0 ng / ml. This level of troponin-T occupies an intermediate position between its level with moderate and severe myocardial damage. Patients with such indicators provide 4% inaccuracy of this method. They need examination and observation in dynamics.

 A particular patient developed a clinic of severe myocardial damage, with impaired hemodynamics. The stabilization of the state was achieved during therapy with cardiac glycosides.

 Example No. 17. Child B. / medical history N 552 / was admitted to the hospital at the age of 9 days with a diagnosis of chronic fetal hypoxia, hypoxic-ischemic cardiopathy, conjugation jaundice.

 The second pregnancy, proceeded with the threat of interruption, anemia. The second birth is urgent, early discharge of amniotic fluid. Birth weight 3400 g, length 53 cm, Apgar score 7/8 points. The condition at receipt of moderate severity, the skin is icteric, breathing is weakened, heart sounds are muffled, soft systolic murmur at all points.

 Similar laboratory and instrumental research methods were carried out. As in example No. 1, the content of troponin-T in the blood serum was determined, which turned out to be 16.0 ng / ml, which indicates a severe myocardial damage. When observing the child in the future for 3-4 weeks, it was revealed that hypoxic-ischemic cardiopathy was difficult, with circulatory disorders, with long-lasting clinical and ECG signs of myocardial damage.

 Example N 18. Child N. / medical history N 1454 / was admitted to the hospital at the age of 5 days with a diagnosis of congenital heart disease, circulatory failure of the second degree A, cerebrovascular accident of the second degree, depression syndrome, acute period.

 The first pregnancy occurred against the background of exhaustive homeostasis, anemia, colpitis, acute respiratory viral infection in the second half. The first delivery is urgent with the early outflow of amniotic fluid, secondary weakness of labor. Birth weight 3400 g, length 54 cm, Apgar score 6/8 points. The condition at admission is serious. The skin is pale with a grayish tint. In the lungs, creaking rales, mainly on the left. Tachypnea up to 72 per minute. Ascultation of the heart region at all points determines a rough systolic murmur with a maximum in the third and fourth intercostal space to the left of the sternum, as well as at the apex. Noise is drawn on the back and left axillary region. The first tone is strengthened in the position of the tricuspid valve, the second tone is accented and split over the pulmonary artery. Tachycardia up to 170 beats per minute. The liver is 2 cm below the edge of the costal arch.

 On the ECG - sinus tachycardia. The electrical axis of the heart is deflected to the right. Blockade of the left anterior and right branches of the bundle of His. Atrioventricular conduction is slowed down. Expressed activity of both ventricles with a violation of the repolarization process. The systolic indicator is shortened. Echocardioscopy - the mitral valve is difficult to locate. An apical examination determines the defect of the interventricular septum in the membranous part - 11 mm. Subcostal examination revealed a low located atrial septal defect - 5 mm.

 Dopplerochocardioscopy - open atrioventricular canal / heart chambers enlarged, common valve - anterior tricuspid valve, posterior mitral valve /.

 Creatine phosphokinase - 0.66 mkkat / l.

 Upon admission, the patient is taken blood from a vein and, as described in example No. 1, a study is carried out. The troponin-T content was 16.0 ng / ml, which indicates severe myocardial damage. Dynamic observation of the patient confirmed the presence of severe myocardial damage. With the progression of symptoms of pulmonary and heart failure at the age of three months, the child died. The clinical diagnosis coincided with the pathologist.

 The proposed method achieves a positive effect: improving the accuracy of diagnosis due to the cardiospecificity of this test, which is ensured by the difference in the amino acid composition of troponin-T of the cardiac and skeletal muscles; a wide diagnostic period, which is due to the long-term preservation of troponin-T in the bloodstream after myocardial damage; the ability to assess the severity of myocardial damage due to different concentrations of troponin-T with moderate to severe myocardial damage. The accuracy of the proposed method is 96%.

 The proposed method can be used in clinical practice, which will provide timely diagnosis of the severity of damage, the ability to detect moderate myocardial lesions in various diseases.

Claims (1)

 A method for assessing the severity of myocardial damage in newborns by examining blood serum, characterized in that the level of troponin-T is examined in the first days of life and when the level of troponin-T is increased from 3.0 to 8.0 ng / ml relative to that in healthy children diagnose moderate myocardial damage, and with an increase in troponin-T from 13.0 to 16.0 ng / ml, severe myocardial damage is diagnosed with hypoxic-ischemic cardiopathy and congenital heart defects.