Cortisol and cytokine responses after surgery in different age groups of pediatric patients
Masatoshi Nakamura1, Sachiyo Suita, Takeshi Yamanouchi
1Department of Pediatric Surgery, Graduate School of Medical Sciences, Reproductive and Developmental Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan. mnakam@med.kyushu-u.ac.jp
Insights
Pediatric patients show varying cortisol and cytokine responses to surgical stress. Neonates exhibit lower C-reactive protein and cortisol levels compared to older children, indicating age-dependent stress responses.
Area of Science:
- Pediatric Surgery
- Immunology
- Endocrinology
Background:
- Surgical stress elicits significant physiological responses, including endocrine and cytokine reactions.
- Understanding age-specific responses is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To investigate and compare the cortisol and cytokine responses to surgical stress across different pediatric age groups.
- To analyze plasma levels of C-reactive protein (CRP), cortisol, interleukin-6 (IL-6), and interleukin-10 (IL-10) in neonates, infants, and pre-school children.
Main Methods:
- A cohort study involving 19 neonates (Group I), 19 infants (Group II), and 20 pre-school children (Group III) undergoing major thoracic and abdominal surgery.
- Blood samples collected preoperatively and at 0, 3, 6, 12, and 24 hours postoperatively.
- Measurement of plasma C-reactive protein (CRP), cortisol, IL-6, and IL-10 levels.
Main Results:
- Peak C-reactive protein (CRP) and cortisol levels were significantly lower in neonates (Group I) compared to infants (Group II) and pre-school children (Group III).
- Interleukin-6 (IL-6) levels peaked postoperatively, with higher concentrations observed in neonates and infants compared to pre-school children.
- Interleukin-10 (IL-10) levels peaked immediately after surgery and showed no significant differences among the age groups.
Conclusions:
- Pediatric patients exhibit distinct endocrine and cytokine responses to surgical stress that vary significantly with age.
- Neonates demonstrate a blunted inflammatory and endocrine response to major surgery compared to older pediatric age groups.
- These findings highlight the importance of age-specific considerations in managing pediatric surgical patients.
Abstract:
We investigated the cortisol and cytokine responses to surgical stress in the different age groups of pediatric patients. This study included 19 neonates (0-6 days old, group I), 19 infants (1-11 months old, group II), and 20 pre-school children (1-5 years old, group III), undergoing major thoracic and abdominal surgery. We obtained blood samples preoperatively and 0, 3, 6, 12, and 24 h postoperatively to measure the plasma levels of C-reactive protein (CRP), cortisol, interleukin (IL)-6, and IL-10. The plasma CRP level in each group reached a peak value on postoperative day 2; however, the peak value was significantly lower in group I than in groups II or III (I vs II, III; p=0.0134, p=0.0017, respectively). The plasma cortisol level in each group reached a peak value just after surgery; however, the peak value was also significantly lower in group I than in groups II or III (I vs II, III; p<0.001, p=0.0104, respectively). The plasma IL-6 level in each group reached a peak level hours postoperatively; however, the peak values in groups I and II were higher than in group III (I, II vs III; p=0.003, p=0.0458, respectively). The plasma IL-10 level in each group reached a peak value just after surgery and did not differ among the three groups. The endocrine and cytokine responses to the surgical stress vary among the different age groups of pediatric patients.
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