Abstract
Severe perinatal asphyxia is associated with myocardial dysfunction in the neonate, however, the contributory roles of hypoglycemia and hypocalcemia is less clear. Serum glucose, total and ionized Ca++ and pH were measured at 0,1,4,24 and 48 hours in 10 term asphyxiated infants (BW=3381±772g, GA=40±1.5 wks). M-mode echocardiograms and serum total creatine phosphokinase (CPK) and CPK isoenzymes were measured during the first 8,24, and 48 hours of life. All neonates had fetal distress as evidenced by severe variable or late decelerations in their fetal heart rate tracing. Eight infants required emergency C-section. One minute Apgar scores in all infants were ≤3. Significant left ventricular (LV) dysfunction was diagnosed in the presence of abnormalities in at least 2 of the following 3 echocardiographic findings: left atrial/aortic ratio >1.3, LV pre-ejection period/LV ejection time ratio >0.42 and the LV shortening fraction < 0.28. Four neonates had evidence of LV dysfunction. The MB fraction of CPK isoenzymes was elevated to a greater extent in these 4 infants. Three of the 4 infants with and only one of the 6 without LV dysfunction had hypoglycemia. Serum ionized Ca++ remained normal in all 10 infants. Conclusion: 1) Hypoglycemia significantly contributes to asphyxial myocardial dysfunction; 2) Hypocalcemia is not a significant contributing factor; 3) Serial measurement of M-mode and MB fraction of CPK isoenzymes identifies asphyxiated neonates with significant myocardial dysfunction.
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Viray, L., Siassi, B., Wu, P. et al. PERINATAL FACTORS LEADING TO LEFT VENTRICULAR DYSFUNCTION IN THE NEONATE. Pediatr Res 18 (Suppl 4), 131 (1984). https://doi.org/10.1203/00006450-198404001-00229
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DOI: https://doi.org/10.1203/00006450-198404001-00229