الفهرس 
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Abstract
Perinatal asphyxia considered one of the most important causes of neonatal morbidity and mortality all over the world especially in the developing countries. Also it stills the major critical health proplem confronts obstetricians and neonatologists almost daily. from the clinical and prognostic point of view, perinatal asphyxia represents amajor topic. Perinatal asphyxia results in hypoxic and/or ischemic injuries to various organs of the newborn and the major target organs involved are kidneys, heart, lungs, liver and brain. Myocardial dysfunction is relatively common in asphyxiated neonates with reported incidence of 26 to 78%.Laboratory usage of Cardiac markers to help in diagnosis of myocardial dysfunction, creatine kinase M.B had been the marker protein of choice for diagnosis of acute myocardial injury for many years. However, CK MB also increased in patient with acute or chronic muscle disease in absence of detectable cardiac injury. Recently, cardiac treponin (T, I, C) has been an area of interest. Cardiac treponin I is an inhibitory protein complex located on the actin filament in all striated muscles. This study aimed to compare serum Creatine Kinase MB (CK-MB) concentrations and cardiac troponin I (cTn I) concentrations among asphyxiated neonates in relation to other clinical and laboratory findings as useful markers of myocardial injury caused by perinatal asphyxia.
This study was carried out on forty neonates (group 1) suffering from perinatal asphyxia admitted to neonatal intensive care units at Menoufiya University Hospital. Another Twenty healthy neonates (group2) control group, matched for age and sex were randomly selected. All neonates in both groups were subjected to, Family’s written consent about all details of the study, detailed perinatal history regarding maternal age, diseases, drug intake, presence of meconium, premature rupture of membranes, prematurity, type of delivery, gestational ages, and full clinical examination including apgar score, neonatal reflexes, general and systemic examinations. Investigations include Umbilical arterial ABG, Umbilical cTnI and CK MB. CBC during first day. After 24 hours age serum CRP, serum electrolytes (Na, K, Ca), BUN, serum creatinine, AST, ALT, were done for both studied groups. Data were collected, tabulated and statistically analyzed. The following findings were obtained:
1. There was no significant difference between both groups as regard sex and body weight.
2. Regarding clinical signs, the asphyxiated neonates showed bradycardia, respiratory signs (bradypnea, cyanosis and apnea) and neurological signs (poor reflexes and abnormal tone).
3. There was a highly significant negative correlation between both (CK MB and cTn I) and Apgar score.
4. According to laboratory investigations, Mean pH, PaO2 and HCO3 of asphyxiated neonates were significantly lower than that of healthy control neonates, and mean PaCO2 of asphyxiated neonates was significantly higher than that of healthy control neonates. Mean Urea, serum creatinine, K, ALT and AST of asphyxiated neonates were significantly higher than that of healthy control neonates. Mean Na and Ca of asphyxiated neonates was significantly lower than that of healthy control neonates. Mean serum cardic troponin I and creatine kinaseMB of asphyxiated neonates were significantly higher than that of healthy control neonates.
5. There was a highly significant negative correlation between both (cTnI & CK MB) and pH, PaO2 and HCO3.
6. There was a significant positive correlation between cTn I and PaCO2 in asphyxiated neonates.
7. There was a significant positive correlation between CK MB and creatinine in asphyxiated neonates.
8. There was also, a significant negative correlation between cTn I and both HGB & platelets count.
9. As regard to death, both CK MB and cTn I showed increased levels in died neonates. 10. Died neonates had worst clinical signs and lower gestational ages and body weights than that of survivor asphyxiated neonates. 11. Mean of hemoglobin, platelets pH and HCO3 of died neonates were significantly lower than that of survivor neonates.
12. Our study showed that the mean of cTn I was higher in died asphyxiated neonates than in survivor asphyxiated neonates.
13. In our study, we found that CK MB elevated in some healthy control cases.
14. In our study, we found that the sensitivity of CK MB=85% and its specificity=89%. And the sensitivity of cTn I=97% and its specificity=95%. So, cTn I is more sensitive and specific than CK MB in prediction of morbidity and mortality of perinatal asphyxia.