ELEVATED CREATININE PHOSPHOKINASE-MYOCARDIAL BOUND FRACTION (CPK-MB) AND PAPILLARY MUSCLE INFARCTION IN STRESSED NEWBORNS SHOWING MYOCARDIAL DYSFUNCTION WITH TRANSIENT TRICUSPID INSUFFIENCY (MD with TTI)

Abstract

We have reported (Bucciarelli et al., Pediatrics, in press) 14 newborns stressed by acute birth hypoxia (and/or hypoglycemia) who developed congestive heart failure, tricuspid insufficiency, and electrocardiographic evidence of myocardial ischemia. Two infants died, each showing tricuspid papillary muscle infarction at autopsy. Subsequently, 13 more stressed newborns, clinically suggesting MD with TTI, have had determinations made of total CPK. Ten had a final clinical diagnosis of MD with TTI. In 9, total CPK was elevated (mean 874 IU/1), in 6 of whom the CPK-MB fraction was elevated to a degree consistent with acute myocardial infarction (mean 185 IU/1). Four of the 10 having MD with TTI died; 2 of these had elevated CPK-MB and papillary muscle infarction; 2 had normal CPK-MB and no infarction at autopsy. Three of the 13 studied had other final diagnosis; (1 with persistent fetal circulation, 2 with congenital heart disease). All had lower mean CPK (107 IU/1) and all had CPK-MB fractions <10 IU/1. We propose that myocardial infarction, particularly of papillary muscle, is part of MD with TTI and is associated with elevation of CPK-MB, and that this enzyme determination may aid differentiation from other cardiopulmonary disease states in the newborn.

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