Abstract
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.
Highlights
With recent advances in surgical techniques and critical care medicine, over 90%of pediatric patients born with congenital heart disease (CHD) survive to adulthood [1].One of the most prevalent morbidities facing this growing population is neurocognitive impairment
Given the similarities in brain injury pathophysiology between term infants experiencing birth asphyxia, premature newborns, and babies born with CHD, we hypothesized that oxidative stress (OS) may play a role in neurologic dysfunction around cardiac surgery [12,13]
Discussion undergoing cardiac surgery is correlated with serum biomarkers of brain damage, intraWe have shown that the OS response, quantified by urinary 8-iso-PGF2α, in infants operative electrical seizures, and abnormal neurological outcomes
Summary
With recent advances in surgical techniques and critical care medicine, over 90%. of pediatric patients born with congenital heart disease (CHD) survive to adulthood [1]. Given the higher concentrations of immature oligodendrocytes and fatty acids existing in the developing brain, infants are prone to OS-induced damage [7]. Given the similarities in brain injury pathophysiology between term infants experiencing birth asphyxia, premature newborns, and babies born with CHD, we hypothesized that OS may play a role in neurologic dysfunction around cardiac surgery [12,13]. In this prospective study, we sought to characterize the relationship between urinary free 8-iso-prostaglandin F2α (8-iso-PGF2α), a biomarker of OS, and clinical and neurological outcomes in infants undergoing cardiac surgery
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