Neonatal sepsis and simple minor neurological dysfunction.

BACKGROUND: This study examined potential risk factors for and consequences of simple minor neurological dysfunction (SMND), in a group of very low-birthweight newborns followed until preschool age. METHODS: This was a prospective longitudinal study. Children with birthweight <1500 g were assessed at 4-6 years of age. Twenty-eight children with normal neurological examination and 35 children with SMND were included in the final analysis. Risk factors for the development of SMND and its association with certain neuropsychiatric conditions were studied. RESULTS: Based on neonatal data, in children with SMND, Apgar score at 1 min (6.13 ± 2.37 vs 7.66 ± 1.04, P = 0.008) and at 5 min (8.63 ± 1.29 vs 9.45 ± 0.65, P = 0.019) was lower, duration of hospital stay was longer (45.8 ± 21.8 vs 35.1 ± 18.2 days, P = 0.037), and the frequency of sepsis was higher (73.5 vs 25%, P < 0.001). Sepsis was found to be an independent risk factor for SMND (OR, 7.6; 95% CI: 2.2-26.0; P = 0.001). The children with SMND had lower intelligence quotient and higher prevalence of hyperactivity and refraction error. CONCLUSION: Postnatal sepsis was the single most important risk factor for the development of SMND, and these children with SMND are at great risk for certain neuropsychiatric conditions. Preventive strategies, particularly for sepsis in the neonatal period, and early diagnosis and rehabilitation of future neuropsychiatric disorders are needed for better management of these cases.

Evaluation of lung function on impulse oscillometry in preschool children born late preterm.

BACKGROUND: There is a paucity of data on lung physiology in late-preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term-born children. METHODS: Children between 3 and 7 years of age who were born late preterm and who were being followed up at the outpatient clinic were included as the late-preterm group. Age-matched healthy term-born children served as controls. A total of 90 late-preterm and 75 healthy children were included in the study. At 5-20 Hz, resistance (R5-R20), reactance (X5-X20), impedans (Z5) and resonant frequency were measured on IOS. RESULTS: Mean IOS R5 and R10 were significantly higher in the late-preterm group than in the control group (P < 0.05). Mean R5, R10 and Z5 were statistically higher in late-preterm children who had been hospitalized for pulmonary infection compared with the control group (P < 0.05). Mean R5, R10, R15, R20 and Z5 were significantly higher, and mean X10 and X15 significantly lower in late-preterm children with passive smoking compared with late-preterm children without passive smoking and controls (P < 0.05). CONCLUSION: Children born late preterm had signs of peripheral airway obstruction on IOS-based comparison with healthy term-born controls. Besides the inherent disadvantages of premature birth, hospitalization for pulmonary infection and passive smoking also seemed to adversely affect lung function in children born late preterm.

Diagnosis, treatment and follow up of neonatal arrhythmias.

OBJECTIVE: This study aimed to evaluate the aetiology, spectrum, course and outcomes of neonates with arrhythmias observed in a tertiary neonatal intensive care unit from 2007 to 2012. METHODS: Neonates with rhythm problems were included. The results of electrocardiography (ECG), Holter ECG, echocardiography and biochemical analysis were evaluated. The long-term results of follow up were reviewed. RESULTS: Forty-five patients were male (68%) and 21 (32%) were female. Fifty-five patients (83.3%) were term, 11 (16.6%) were preterm, and 34% were diagnosed in the prenatal period. Twenty cases (30.3%) had congenital heart disease. Twenty-three patients (34.8%) were diagnosed during the foetal period. The most common arrhythmias were supraventricular ectopic beats and supraventricular tachycardia (SVT) at 39.3 and 22.7%, respectively. SVT recurred in five patients after the neonatal period. CONCLUSION: Supraventricular ectopic beats and SVT were the most common arrhythmias during the neonatal period. Although the prognosis of arrhythmias in the neonatal period is relatively good, regular monitoring is required.

The effect of IVF pregnancies on mortality and morbidity in tertiary unit.

BACKGROUND: There are several studies that have shown an increased risk of premature birth and developmental abnormalities with in vitro fertilization (IVF); however, the data on preterm mortality and morbidity are limited. AIM: Our aim is to investigate whether IVF had an effect on the mortality and morbidity in neonates admitted to the neonatal intensive care unit. METHODS: A total of 940 term and preterm babies who were admitted to the intensive care unit over a period of 2 years were enrolled. Of these, 121 babies were born after IVF and 810 were born after a natural conception and 9 were born after ovulation induction. Of these, 112 preterm babies were born after IVF and 405 preterm babies were born after a natural conception. RESULTS: In the IVF group, the gestational age and birth weight were significantly lower than in the non-IVF group. Additionally, in the IVF group, multiple births were significantly higher than in the non-IVF group. IVF pregnancies increase preterm delivery but did not increase preterm mortality, and preterm morbidity did not differ among groups, except for intraventricular hemorrhage (IVH). Gestational age was shown to be the primary risk factor for IVH using a logistic regression analysis. Also when newborns at gestational age <32 weeks were compared using regression analysis, gestational age was the major risk factor for IVH. CONCLUSION: IVF appears to be associated with premature delivery and the known risks associated with prematurity.

Effect of heavy metals in the meconium on preterm mortality: preliminary study.

BACKGROUND: There have been many studies that have investigated the risk factors of mortality in preterm infants, but none has shown an association between preterm mortality and exposure to heavy metals or trace elements. The aim of this study was therefore to measure the levels of toxic metals (lead, cadmium) and trace elements (zinc, iron, copper) in meconium samples and elucidate their association with preterm mortality. METHODS: Metals and trace elements were measured in the meconium of 304 preterm infants using a flame atomic absorption spectrophotometer. RESULTS: The level of heavy metals and trace elements in non-surviving infants was significantly higher than in surviving infants. Moreover, the level of heavy metals and trace elements in non-surviving infants whose gestational age was <30 weeks (n = 11) was significantly higher than in surviving infants (n = 12). Receiver operating characteristic curve analysis showed that gestational age and meconium lead level predicted early mortality in premature newborns. Furthermore, this curve analysis showed that, when comparing meconium lead level and gestational age, meconium lead level had a similar effect on mortality as gestational age. CONCLUSION: Meconium lead level and gestational age are associated with increased mortality risk in preterm neonates.

Value of homocysteine levels, troponin I, and score for neonatal acute physiology and perinatal extension II as early predictors of morbidity.

BACKGROUND: Although the effects of cardiac troponin I (cTnI) have been documented in infants, the associations among the value of maternal and cord blood total homocysteine (Hcy) levels, cord blood cTnI and the score for neonatal acute physiology and perinatal extension II (SNAPPE-II) values in infants have not been documented. The aim of this study was to determine the value of maternal total Hcy (mtHcy) and cord blood total Hcy (ctHcy) levels, cTnI and SNAPPE-IIas predictive factors of morbidity in newborns. METHODS: Maternal and cord blood samples were routinely collected for analysis from all prospective participating volunteers. In this case­control study, both hospitalized (n = 71) and non-hospitalized (n = 148) newborns were identified and followed until discharge. RESULTS: Regression analysis revealed that pre-eclampsia, gestational age, mtHcy and SNAPPE-II values were significantly and independently associated with morbidity. Cord blood pH, ctHcy levels, SNAPPE-II values, and pre-eclampsia were associated with mtHcy levels. A similar association was found among cTnI, cord blood pH, mtHcy levels and ctHcy levels. The specificity and sensitivity values of mtHcy in predicting newborn morbidity were 62% and 78%, respectively,while the specificity and sensitivity values of SNAPPE-II in predicting newborn morbidity were 96% and 97%,respectively. CONCLUSIONS: Elevated mtHcy levels were associated with cTnI, SNAPPE-II values, cord blood gas, and neonatal morbidities. These results suggest that SNAPPE-II may be an early predictor of morbidity after delivery and that elevated mtHcy levels may be an early prenatal biomarker of morbidity in newborns.

Neonatal hyperbilirubinemia and organic anion transporting polypeptide-2 gene mutations.

The aim of this study was to investigate the genotypic distribution of organic anion transporting polypeptide 2 (OATP-2) gene mutations and the relationship with hyperbilirubinemia of unknown etiology. Polymerase chain reaction, restriction fragment length polymorphism, and agarose gel electrophoresis techniques were used for detection of OATP-2 gene mutations in 155 newborn infants: 37 with unexplained hyperbilirubinemia, 65 with explained hyperbilirubinemia, and 53 without hyperbilirubinemia. In the OATP-2 gene, we identified A→G transitions at nucleotide positions 388 and 411 and observed six polymorphic forms. The 388/411-411 mutation was the most common form (43%) in subjects with hyperbilirubinemia of unknown etiology. Male sex [odds ratio (OR): 3.08] and two polymorphic forms of the OATP-2 gene [the 388/411-411 A→G mutation (OR: 3.6) and the 388-411 mutation (OR: 2.4)] increased the risk of neonatal hyperbilirubinemia. In male infants with the 388 A→G mutation of the OATP-2 gene, the levels of unconjugated bilirubin in plasma were significantly increased compared with those observed in females. The polymorphic forms of 388 nucleotide of the OATP-2 gene were identified as risk factors for hyperbilirubinemia of unknown etiology.

Acute renal failure SNAPPE and mortality.

BACKGROUND: The aim of the present study was to determine, using the score for neonatal acute physiology and perinatal extension II (SNAPPE-II), whether there is an association with acute renal failure (ARF) and whether it is possible to identify newborns at risk for ARF prior to a rise in creatinine in newborns. METHODS: Information on postnatal risk factors and SNAPPE-II on the first day of life (non-ARF group, n= 475; ARF group, n= 78) were collected. Renal failure was defined as serum creatinine level >1 mg/dL and >1.3 mg/dL (for ≥ 33 weeks and < 33 weeks, respectively) after 48 h of life. RESULTS: In newborns with ARF (n= 78), the median (range) of SNAPPE-II and mortality rate were significantly higher than those of the control group. Patent ductus arteriosus (PDA), disseminated intravascular coagulation (DIC), SNAPPE-II, and resuscitation were identified as independent predictors of ARF in infants on forward stepwise logistic regression. Sepsis, respiratory distress syndrome, ARF, DIC, and SNAPPE-II were identified as independent predictors of mortality in infants on the same analysis. CONCLUSIONS: SNAPPE-II on the first day of life was significantly higher among babies with ARF, suggesting a positive association between higher scores and the development of ARF and mortality, but based on receiver operating characteristic curve results, SNAPPE-II at admission did not enhance the assessment of risk for ARF prior to a rise in creatinine.

Effect of silicon gel sheeting in nasal injury associated with nasal CPAP in preterm infants.

We conducted this study to investigate the efficacy of the silicon gel application on the nares in prevention of nasal injury in preterm infants ventilated with nasal continuous positive airway pressure (NCPAP). Patients (n=179) were randomized into two groups: Group 1 (n=87) had no silicon gel applied to nares, and in Group 2 (n=92), the silicon gel sheeting was used on the surface of nares during ventilation with NCPAP. Nasal injury developed in 13 (14.9%) neonates in Group 1 and 4 (4.3%) newborns in Group 2 (OR:3.43; 95% CI: 1.1-10.1; P<0.05). The incidence of columella necrosis was also significantly higher in the Group 1 (OR: 6.34; 95% CI: 0.78-51.6; P<0.05). We conclude that the silicon gel application may reduce the incidence and the severity of nasal injury in preterm infants on nasal CPAP.

Surgical experience in a baby with congenital broncho-biliary fistula.

Congenital tracheobiliary and bronchobiliary fistulae are rare malformations in which patent communications exist between the respiratory system and biliary tract, respectively. We present a newborn who was admitted with respiratory distress and bilious tracheal discharge. Investigation revealed a bronchobiliary fistula originating from the left main bronchus, as well as biliary atresia. Excision of the bronchobiliary fistula was successful and the connection between biliary tract and gastrointestinal system was established by performance of a Roux-en-Y cholecysto-jejunostomy. Diagnostic tools, differential diagnosis, and surgical correction strategies are discussed.

[Is serologic screening necessary in the donor bloods for cytomegalovirus seronegative blood transfusion to risky patients?]. / Riskli gruplara sitomegalovirus seronegatif kan transfüzyonu için bagisçi kanlarinda tarama gerekli mi?

Cytomegalovirus (CMV) infections are commonly seen in humans and are usually mild or asymptomatic. However, these infections have significant medical risks in pregnant women, newborns and immunocompromised patients. Seronegative subjects and infants acquire CMV through infected blood products or direct contact with infected people. The use of seronegative blood products for selected patients, as in newborns and/or immunosuppressed patients has vital importance in medical management. Providing seronegative blood in countries where the prevalence of CMV is high (>90%), is difficult since this requires screening of a great number of blood donations. The aim of this study was to detect the CMV seroprevalence among voluntary blood donors in Kocaeli (located at northwestern region of Turkey) and to determine whether the screening procedure was cost-effective. CMV-IgG was investigated by a commercial ELISA method (AXSYM, Abbott, USA) in 1264 blood donors who were voluntarily admitted to donate blood for newborns between January to December 2006. In 1229 (97.2%) of these donors CMV-IgG was found positive while it was negative in 35 (2.8%). It was estimated that CMV-IgG screening was not cost-effective to provide seronegative blood donations because of the high rate of seropositivity in Kocaeli as well as other regions of Turkey, so it would be more favorable to apply alternative methods such as leukocyte reduction.

Late haemorrhagic disease of the newborn.

BACKGROUND: Late haemorrhagic disease of the newborn (HDN) can occur owing to a lack of vitamin K prophylaxis, as a manifestation of an underlying disorder or idiopatically from the 8th day to 12 weeks after birth. METHODS: Eight infants admitted to Kocaeli University Hospital with nine episodes of late HDN between January 2002 and April 2005 were evaluated retrospectively from hospital records. RESULTS: The median age at presentation was 46 (26-111) days. All the infants were born at full-term to healthy mothers and were exclusively breast-fed. All had an uneventful perinatal history, except one who had meconium aspiration. Four patients had received no vitamin K prophylaxis and another three had uncertain histories. At presentation, six had intracranial bleeding and the remainder had bleeding either from the venepuncture site or the gastro-intestinal tract. The presenting signs and symptoms were irritability, vomiting, bulging or full fontanelle, convulsions and diminished or absent neonatal reflexes. Galactosaemia was detected in a 2-month-old infant with prolonged jaundice. There was no surgery-related mortality or complications but one survived for only 2 days on ventilatory support following surgery. Only one of the six survivors had severe neurological sequelae. CONCLUSIONS: Late HDN frequently presents with intracranial haemorrhage, leading to high morbidity and mortality. HDN can be the manifestation of an underlying metabolic disorder. Vitamin K prophylaxis of the newborn should be routine in developing countries.

Concentrations of toxic metals and trace elements in the meconium of newborns from an industrial city.

OBJECTIVE: To investigate fetal exposure to toxic metals [lead (Pb), cadmium (Cd)] and fetal levels of trace elements [zinc (Zn), copper (Cu), and iron (Fe)] in newborns from an industrial city. Relationships between meconium mineral contents and parental occupation and location of residence were also tested. METHOD: The meconium mineral contents of 117 healthy newborn infants were measured by flame atomic absorption spectrophotometer. RESULTS: The median concentrations (interquartile range) of toxic metals and trace elements in the meconium were as follows: Pb: 46.5 (1,399) microg/g dry weight (wt), Cd: 2.3 (55.6) microg/g dry wt; Zn: 234 (3,049) microg/g dry wt; Cu: 11.8 (818.7) microg/g dry wt, and Fe 105 (2,980) microg/g dry wt. All the meconium samples contained both toxic metals and trace elements. The proportions of trace elements in the meconium samples with concentration higher than 100 microg/g dry wt of the substances tested were Zn 90%, Cu 64%, and Fe 53%. There were significantly positive correlations between the concentrations of toxic metals and trace elements. Also there were positive correlations between the levels of Zn, Fe, and parental occupations, and between the level of Fe and location of residence of the parents (proximity to the petroleum refinery or the dye industries). CONCLUSION: All the meconium samples were positive for toxic metals, and thus may reflect environmental pollution in the city. The occupation environments and the location of the family residence are linked with levels of trace elements in meconium.

Rickets-like radiological and biochemical features of neonatal mucolipidosis II (I-cell disease): report of two cases.

In this paper, two cases with mucolipidosis type II (I-cell disease) (proven in one presenting newborn and presumed in an elder deceased brother) are presented. These infants showed severe skeletal changes with diffuse periosteal new bone formation in long bones and ribs, marked osteopenia, and resorption of scapula, clavicula, and mandible. There was also irregular demineralization of metaphyses of long tubular bones, as seen in rickets. The activities of serum alkaline phosphatase and parathyroid hormone were markedly elevated. Phosphorus was decreased. Serum 1,25-dihydroxyvitamin D was slightly elevated, but 25-hydroxyvitamin D and calcium were normal. Dysostosis multiplex resembling rickets and very high alkaline phosphatase activity were due to defective osteoblastic activity, but the mechanism of elevated parathyroid hormone was not clear. We conclude that early skeletal manifestation of mucolipidosis type II is not clearly identified and that differentiation from congenital rickets or congenital hyperparathyroidism could be difficult. It is speculated that hyperparathyroidism in these patients could be related to the calcium-sensing receptor malfunction in the parathyroid gland.

The effect of early recombinant erythropoietin and enteral iron supplementation on blood transfusion in preterm infants.

Premature infants<1500 g were randomly assigned to study and control groups. In the study group, 42 premature infants received recombinant human erythropoietin (r-Hu EPO) 750 U/kg per week subcutaneously from day 5 to 40 and enteral iron supplementation of 2 to 6 mg/kg/d beginning on day 14 provided that they were receiving at least 50% energy intake orally. In the control group, 51 infants received the same dose of enteral iron supplementation beginning at the end of the fourth week. At the end of a 12-week monitoring period, r-Hu EPO combined with early enteral iron reduced transfusion needs only in the subgroup<1000 g. r-Hu EPO and early iron treatment had no effect on the development of severe retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia. We suggest that r-Hu EPO combined with early enteral iron is both effective and safe in infants<1000 g.

An outbreak of SHV-5 producing Klebsiella pneumoniae in a neonatal intensive care unit; meropenem failed to avoid fecal colonization.

An outbreak of extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae (ESBL-Kp) in a neonatal intensive care unit prompted a prospective surveillance study between 12th September and 6th October 2003. Surveillance was carried out by obtaining stool samples twice a week. The DNA relatedness of the isolates was shown by random amplified polymorphic DNA comparison (ERIC-PCR). ESBL production was identified by clavulanate synergy, isoelectric focusing, PCR and sequence analysis. During the study period, 49 neonates were hospitalized in the neonatal intensive care unit (NICU). In the first 20-day period, five neonates were infected with ESBL-Kp. The first patient treated with third generation cephalosporin and the second patient treated with meropenem died. While all three infected survivors were clinically improving, the digestive tracts were being colonized by SHV-5 producing Klebsiella. In the next period of the study, five neonates were colonized by ESBL-Kp as well. Univariate comparison of risk factors between colonized and non-colonized neonates was not significant. A total of 24 colonally related ESBL-Kp have been recovered from clinical materials and stool samples. This study demonstrated that parenterally applied meropenem, though successful in treating the systemic illness, might fail to protect the digestive tract from colonization of ESBL-Kp.

Complement 4 levels as early predictors of poor response to surfactant therapy in respiratory distress syndrome.

The aim was to determine whether stronger complement activation is an early predictor of poor response to surfactant treatment in infants with severe respiratory distress syndrome (RDS). Thirty-one preterm newborns with severe RDS (initial fraction of inspired oxygen [FiO (2)] > 0.5) and 22 healthy preterm newborns were studied. The study group was divided into two subgroups according to their response to natural surfactant 6 hours after administration: good responders had reduction in FiO (2) > 50% of the presurfactant level, and poor responders had a reduction in FiO (2) < or = 50%. Levels of complement 4 (C4) and C3c were measured in blood samples drawn at admission and 24 hours after birth. The poor responders to surfactant had significantly lower serum C4 levels at admission and in the first day of life than the good responders. The poor responders also had lower C3c levels at birth than the good responders, but higher C3c levels at 24 hours. Receiver-operator curve analysis revealed that, compared with C3c at admission, C4 at admission was a more sensitive and specific predictor of poor response to surfactant treatment in preterm newborns with severe RDS (area under the curve, 0.863; 95% confidence interval, 0.726 to 1; p = 0.001). Significantly decreased serum C4 at admission is a valuable early predictor of poor response prior to surfactant treatment in preterm newborns with severe RDS. C4 level may help investigators determine the mechanisms underlying poor responsiveness to surfactant.

Early prognostic significance of umbilical cord troponin I in critically ill newborns. Prospective study with a control group.

AIM: To determine the value of cord blood cardiac troponin I levels (cTnl) as an early prognostic factor in critically ill newborns, and to compare cord cTnl levels with the prognostic value of the score for neonatal acute physiology (SNAP). METHODS: Cord arterial samples were collected routinely for blood gas analysis, and cord venous samples for cTnl and cardiac-specific creatine kinase assay. The study group (n=109) comprised critically ill newborns who required mechanical ventilation. The control group (n = 96) comprised newborns who were either completely healthy (n = 48) or were followed in a level I neonatal care unit due to moderate-severity problems. RESULTS: The critically ill newborns had significantly higher cTnl levels than control babies (median [min-max] 1.4 [0-13] vs. 0 [0-1.8] ng/mL, respectively; P<0.001). In critically ill newborns, non-survivors had significantly higher cTnl levels than survivors (median [min-max] 6.6 [1.3-13.0] vs. 1.3 [0-8.0] ng/mL, respectively; P<0.001). Receiver-operator curve analysis revealed that, compared with SNAP, cTnl was a more sensitive predictor of mortality in critically ill newborns (area under curve=0.96; 95% CI=0.90-1.02). CONCLUSION: Significantly elevated cord cTnl may be a valuable predictor of mortality in critically ill newborns.

The effect of blood gas and Apgar score on cord blood cardiac troponin I.

OBJECTIVES: The aims of this study were to (a) establish a reference range for cardiac troponin I (cTnI) in the cord blood of healthy infants, and (b) investigate the effect of Apgar score, cord blood gas, gestational age, and creatine kinase (CK) and creatine kinase MB (CK-MB) fraction levels on cord blood cTnI levels. METHODS: 112 perinatal hypoxic and 84 control newborns without perinatal hypoxia were enrolled in this study. Cord blood samples were collected from the babies for arterial blood gas analysis, cTnI, CK and CK-MB measurements. Gestational age, birth weight, sex, Apgar score and history of fetal distress were recorded. Hypoxic ischemic encephalopathy (HIE) group, hypoxic but without HIE group and control groups were identified according to clinical observations during the first 72 h in the newborn unit. RESULTS: HIE and perinatal hypoxic without HIE groups had a significantly higher cord blood cTnI level according to the control group (1.8 ng/mL (0-13), 0 ng/ml (0-1.1) and 0 ng/ml (0-0.3) respectively). Cord blood cTnI level did not have a correlation with birth weight and gestational age (r = -0.02, p > 0.05 and r = 0.08, p > 0.05 respectively). Cord blood cTnI level also had a negative correlation with pH, bicarbonate, base deficit, and Apgar score (r = -0.40, p < 0.001; r = -0.39 p < 0.001; r = -0.45 p < 0.001; r = -0.41, p < 0.001) respectively). Cord blood cTnI level showed a positive correlation with CK and CK-MB levels (r = 0.45, p < 0.001 and r = 0.37, p < 0.001 respectively). Receiver operator curve analysis revealed that the most sensitive factor for prediction of perinatal hypoxia is cord cTnI value [area under curve = 0.929]. The optimal cut-off value of cord cTnI was 0.35 ng/ml for hypoxia. CONCLUSION: cTnI levels in the cord blood are not affected by gestational age and birth weight. cTnI together with CK and CK-MB has been found to be elevated in hypoxic infants compared to normal infants. Therefore cTnI may be an indicator for perinatal hypoxia in neonates.

Cord blood cardiac troponin I as an early predictor of short-term outcome in perinatal hypoxia.

BACKGROUND: In most perinatal-hypoxia survivors, myocardial dysfunction can be reversed with appropriate inotropic support and oxygenation. The main problem related to outcome is cerebral damage. OBJECTIVE: We tested the hypothesis that cardiac troponin I (cTnI), a known marker of myocardial injury, is also an early predictor of severity of cerebral damage and mortality in intrauterine hypoxia. METHODS: Venous and arterial cord blood samples were collected at delivery from 54 consecutive newborns with hypoxic-ischemic encephalopathy and from 50 consecutive healthy controls. Arterial blood gas analysis was performed and levels of cTnI, creatine kinase and creatine kinase-MB in venous cord blood were measured. The same serum parameters were also measured on the 3rd and 7th day of life. RESULTS: Infants with hypoxia had a significantly higher cord blood cTnI levels than controls (p < 0.0001). Cord blood and 3rd and 7th day serum cTnI values showed a significant increase with severity of HIE (p < 0.0001). In non-survivors cord blood cTnI levels were significantly higher than the survivors (5.9 ng/ml, range 2.1-12.8, and 1.6 ng/ml, range 0.4-5.8, respectively; p < 0.0001). Receiver-operator curve analysis revealed cord cTnI as the most sensitive factor for predicting early death (area under curve = 0.956; SE: 0.028; 95% CI: 0.9-1.01). Cord blood cTnI of 4.6 ng/ml was identified as the optimal cut-off level for predicting serious risk of early mortality. CONCLUSION: The results suggest that significant elevation of cord cTnI is an excellent early predictor of severity of hypoxic-ischemic encephalopathy and mortality in term infants.