- Myocardial dysfunction as a component of multiple organ discrepancy with neonatal sepsis
Myocardial dysfunction as a component of multiple organ discrepancy with neonatal sepsis
Ukrainian Journal of Perinatology and Pediatrics. 2022. 2(90): 12-16; doi 10.15574/PP.2022.90.12
Kretsu N. М., Koloskova О. К., Shakhova О. О.
Bukovinian State Medical University, Chernivtsi, Ukraine
For citation: Kretsu NМ, Koloskova ОК, Shakhova ОО. (2022). Myocardial dysfunction as a component of multiple organ discrepancy with neonatal sepsis. Ukrainian Journal of Perinatology and Pediatrics. 2(90): 12-16; doi 10.15574/PP.2022.90.12.
Article received: Feb 03, 2022. Accepted for publication: Apr 27, 2022.
The formation of myocardial dysfunction in neonatal sepsis remains a topical issue in current neonatal practice. Myocardial dysfunction with neonatal sepsis is found to promote a double increase of neonatal loss rate, and maintenance of an adequate cardiac output is very important predictor for survival of patients with neonatal sepsis.
Purpose – to study clinico-paraclinical markers of myocardial dysfunction in case of an alternative term of neonatal sepsis debut for timely verification and rational correction of cardiovascular disorders.
Materials and methods. Considering various terms of neonatal sepsis manifestation with its early and late variants, a comparative analysis of clinical-paraclinical markers of generalized infectious-inflammatory process was made in 26 neonates at the stage of obstetrical aid (retrospective analysis) and in the intensive care departments for neonates and their resuscitation (prospective follow-up). According to the results of the analysis of medical records of newborns, the diagnosis of early neonatal sepsis was established in 14 (53.8%) newborns who were included in the clinical group I of the study, and the diagnosis of late neonatal sepsis was established in 12 (46.2%) newborns who were included in the clinical group II.
Results. After birth general condition of patients from the group I was assessed as of moderate severity – in 1 (7.1%) and severe – in 13 (92.9%) neonates; in the group II the 2 neonates (16.7%) were in the condition of moderate severity (р>0.05) and 10 (83.3%) neonates were in severe condition (р>0.05). Assessment of cardiovascular constituent in the neonatal groups of comparison according to the constellation scale nSOFA in the means values did not differ reliably, though it was indicative of a tendency to deeper disorders in case of late neonatal sepsis.
Conclusions. Sepsis-induced myocardial dysfunction is manifested by increase in the content of cardio-specific markers (creatine phosphokinase, МВ fraction, troponin I). An increased content of troponin I in the blood higher than that of the norm in case of late neonatal sepsis possesses a high inclination (83.3%) to the formation of myocardial dysfunction.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: neonates, neonatal sepsis, myocardial dysfunction.
REFERENCES
1. Denning NL et al. (2020). Extracellular CIRP as an endogenous TREM-1 ligand to fuel inflammation in sepsis. JCI Insight. 5: e134172. https://doi.org/10.1172/jci.insight.134172; PMid:32027618 PMCid:PMC7141396
2. Denning NL, Aziz M, Diao L, Prince JM, Wang P. (2020). Targeting the eCIRP / TREM-1 interaction with small molecule inhibitor improves cardiac dysfunction in neonatal sepsis. Mol Med. 26 (1): 121. https://doi.org/10.1186/s10020-020-00243-6; PMid:33276725 PMCid:PMC7716442
3. Drosatos K et al. (2015). Pathophysiology of sepsis-related cardiac dysfunction: driven by inflammation, energy mismanagement, or both? Curr Heart Fail Rep. 12: 130-140. https://doi.org/10.1007/s11897-014-0247-z; PMid:25475180 PMCid:PMC4474734
4. Fleiss N, Coggins SA, Lewis AN, Zeigler A, Cooksey KE, Walker LA, Husain AN, de Jong BS, Wallman-Stokes A, Alrifai MW, Visser DH, Good M, Sullivan B, Polin RA, Martin CR, Wynn JL. (2021). Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants With Late-Onset Infection. JAMA Netw Open. 4 (2): e2036518. https://doi.org/10.1001/jamanetworkopen.2020.36518; PMid:33538825 PMCid:PMC7862993
5. Gan MY, Lee WL, Yap BJ, Seethor STT, Greenberg RG, Pek JH, Tan B, Hornik CPV, Lee JH, Chong SL. (2022). Contemporary Trends in Global Mortality of Sepsis Among Young Infants Less Than 90 Days: A Systematic Review and Meta-Analysis. Front Pediatr. 10: 890767. https://doi.org/10.3389/fped.2022.890767; PMid:35722477 PMCid:PMC9204066
6. Lv X, Wang H. (2016). Pathophysiology of sepsis-induced myocardial dysfunction. Mil Med Res. 3: 30. https://doi.org/10.1186/s40779-016-0099-9; PMid:27708836 PMCid:PMC5037896
7. Martin L et al. (2016). The synthetic antimicrobial peptide 19-2.5 attenuates septic cardiomyopathy and prevents down-regulation of SERCA2 in polymicrobial sepsis. Sci Rep. 6: 37277. https://doi.org/10.1038/srep37277; PMid:27853260 PMCid:PMC5112529
8. Martin L et al. (2019). The septic heart: current understanding of molecular mechanisms and clinical implications. Chest. 155: 427-437. https://doi.org/10.1016/j.chest.2018.08.1037; PMid:30171861
9. McGovern M, Miletin J. (2018). Cardiac Output Monitoring in Preterm Infants. Front Pediatr. 6: 84. https://doi.org/10.3389/fped.2018.00084; PMid:29666787 PMCid:PMC5891589
10. Mironov PI, Lekmanov AU. (2021). Otsenka validnosti shkalyi nSOFA u novorozhdennyih s sepsisom. Vestnik anesteziologii i reanimatologii. 18 (2): 56-61. https://doi.org/10.21292/2078-5658-2021-18-2-56-61
11. Romero-Bermejo FJ, Ruiz-Bailen M, Gil-Cebrian J, Huertos-Ranchal MJ. (2011). Sepsis-induced Cardiomyopathy. Curr Cardiol Rev. 1: 163-183. https://doi.org/10.2174/157340311798220494; PMid:22758615 PMCid:PMC3263481
12. Sun X et al. (2015). The activation of EGFR promotes myocardial tumor necrosis factor-alpha production and cardiac failure in endotoxemia. Oncotarget. 6: 35478-35495. https://doi.org/10.18632/oncotarget.6071; PMid:26486084 PMCid:PMC4742119
13. Sun XQ, Abbate A, Bogaard HJ. (2017). Role of cardiac inflammation in right ventricular failure. Cardiovasc Res. 113: 1441-1452. https://doi.org/10.1093/cvr/cvx159; PMid:28957536
14. Wynn JL, Kelly MS, Benjamin DK et al. (2017). Timing of multiorgan dysfunction among hospitalized infants with fatal fulminant sepsis. Am J Perinatol. 34: 633-639. https://doi.org/10.1055/s-0036-1597130; PMid:27923248 PMCid:PMC5604435
15. Wynn JL, Polin RA. (2020). A neonatal Sequential Organ Failure Assessment score predicts mortality to late-onset sepsis in preterm very low birth weight infants. Pediatr Res. 88 (1): 85-90. https://doi.org/10.1038/s41390-019-0517-2; PMid:31394566 PMCid:PMC7007331