P-40 Brain injury and neuromarker changes in children undergoing cardiac surgery with cardiopulmonary bypass

Abstract

The S100β protein and neuron specific enolase (NSE) are sensitive brain injury markers. The aim was to study S100β protein and NSE changes in children with congenital heart disease with/without chronic hypoxaemia who underwent cardiac surgery during cardiopulmonary bypass (CPB). Twenty four children underwent cardiac surgery with CPB and unexpected perfusion problems. Group I: 10 pts with VSD, 4.5±2.7 yr, 15.2±6.1 kg. Group II: 14 pts with tetralogy of Fallot, 4.4±2.5 yr; 14.4±5.7 kg. We studied the level of neuromarkers of jugular bulb blood at 4 stages: S1 - initial stage; S2 - CPB initiation; S3 - end of surgery; S4 - next day after surgery. Neurological assessments of children were made before and after surgery. Data were compared using t-test and correlation analysis was performed. Frequency of postoperative neurological complications (post-ischaemic brain oedema, subdural haematoma, encephalopathy) in group I was 20%, postoperative mortality 10%; in group II, 31% and 21.7% respectively. We have found correlation between S100β protein and rate of postoperative neurological complication (r=0.61), between S100β protein and rate of postoperative mortality (r=0.77) and between NSE and neurological complication (r=0.71) in group II.TableChanges of neuromarkers in children who underwent cardiac surgeryStagesneuron specific enolase (mg/L)S100β protein (ng/L)Gp IGp IIGp IGp IIS131.1 ± 35.556.9 ± 35.0#P<0.05 between groups.103.7 ± 91.9236.1 ± 116.1#P<0.05 between groups.S233.0 ± 31.357.5 ± 35.8 #P<0.05 between groups.108.3 ± 94.3175.5 ± 100.5⁎P<0.05 in comparison with stage 1;#P<0.05 between groups.S329.1 ± 28.764.2 ± 33.9#P<0.05 between groups.119.5 ± 80.2⁎P<0.05 in comparison with stage 1;183.9 ± 99.3⁎P<0.05 in comparison with stage 1;#P<0.05 between groups.S432.7 ± 31.262.3 ± 33.7#P<0.05 between groups.95.3 ± 70.3197.2 ± 95.3#P<0.05 between groups. P<0.05 in comparison with stage 1;# P<0.05 between groups. Open table in a new tab S100β protein and NSE are highly sensitive and predictive markers of neurological outcomes after paediatric cardiac surgery with CPB. Brain injury after CPB complications is higher and severe in patients with chronic hypoxaemia.