| Autor: |
Cañizo Vázquez D; BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain., Hadley SM; Department of Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA., Pérez Ordóñez M; Pediatric Cardiology Department, Sant Joan de Déu Hospital, Cardiovascular Research Group, Sant Joan de Deu Research Institute, 08950 Barcelona, Spain., Lopez-Abad M; BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain., Valls A; Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, 08950 Barcelona, Spain., Viñals ML; Department of Anesthesia, Hospital Sant Joan de Déu, 08950 Barcelona, Spain., Moscoso BA; Department of Cardiothoracic Surgery, Hospital Sant Joan de Déu, 08950 Barcelona, Spain., Benito Fernandez S; Department of Pediatric Critical Care, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain., Camprubí-Camprubí M; Cardiovascular Research Group, Sant Joan de Deu Research Institute, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain., Sanchez-de-Toledo J; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. |
| Abstrakt: |
Pediatric cardiac surgery induces an increased oxidative stress (OS) response. Increased OS is associated with poor neurologic outcomes in neonatal populations with similar patterns of brain injury. We investigated OS and brain injury in infants undergoing heart surgery. Patients 6 months or younger, undergoing cardiac surgery with or without cardiopulmonary bypass (CPB), were included in this prospective, observational study. Patients were divided into infant (30 days−6 months) and neonatal (<30 days) groups for analysis. Urine OS biomarker 8-iso-prostaglandin F2α (8-iso-PGF2α) was quantified pre-surgery and at 0 and 24 h post-surgery. A serum brain damage biomarker S100B protein was also measured pre-surgery and at 0 and 72 h post-surgery. Amplitude-integrated electroencephalography during surgery was analyzed. Neuropsychological evaluation using the Bayley III or Vineland test was performed in all patients at 24 months of age. Sixty-two patients were included, 44 of whom underwent follow-up neurologic evaluation. 8-iso-PGF2α and S100B levels were increased after surgery. Postoperative levels of S100B were positively correlated with 8-iso-PGF2α levels 24 h after surgery (rho = 0.5224; p = 0.0261). There was also a correlation between immediate post-surgery levels of 8-iso-PGF2α and intra-surgery seizure burden (rho = 0.4285, p = 0.0205). Patients with an abnormal neurological evaluation had increased levels of S100B 72 h after surgery (p = 0.048). 8-iso-PGF2α levels 24 h after surgery were also related to abnormal neurologic outcomes. Levels of 8-iso-PGF2α following pediatric cardiac surgery are associated with several indicators of brain injury including brain damage biomarkers, intra-operative seizures, and abnormal neurological evaluation at follow-up, suggesting the importance of oxidative stress response in the origin of brain damage in this population. |
