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Early induction of IL-6 in infants undergoing major abdominal surgery
1Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Infants undergoing major surgery show an early increase in interleukin-6 (IL-6), a key cytokine. This response, independent of other cytokines, correlates with heart rate changes during surgery.
Area of Science:
- Pediatric Surgery
- Immunology
- Surgical Stress Response
Background:
- Infants undergoing major surgery face risks like sepsis and altered metabolic responses.
- Understanding cytokine dynamics in pediatric surgical stress is crucial for managing host response.
Purpose of the Study:
- To investigate the temporal cytokine response in infants during major surgery.
- To correlate cytokine levels with hemodynamic and biochemical parameters.
Main Methods:
- Six infants undergoing pull-through operation for Hirschsprung's disease were studied.
- Interleukin-6 (IL-6), interleukin-1 beta (IL-1 beta), and tumor necrosis factor-alpha (TNF-alpha) were measured via ELISA.
- Measurements were taken preoperatively, hourly during surgery, and 24/48 hours postoperatively.
Main Results:
- IL-6 levels significantly increased within 2 hours of surgery, peaking at 24 hours postoperatively.
- No significant changes in IL-1 beta or detectable TNF-alpha were observed.
- Elevated cortisol and C-reactive protein were noted postoperatively.
- Increased heart rate correlated with IL-6 levels, but blood pressure and temperature did not.
Conclusions:
- Interleukin-6 (IL-6) is the earliest detectable cytokine response to major surgical stress in infants.
- IL-6 can be upregulated independently of other measured cytokines during surgical stress.
Abstract:
Cytokines are immunoregulatory molecules that are important mediators of the host response to stress and infection. Infants and children undergoing major surgery are particularly at risk of developing sepsis and have altered metabolic responses to surgical stress compared to adults. We have investigated the temporal sequence of cytokine responses in six infants (mean age, 11 +/- 7.5 months) undergoing pull-through operation for Hirschsprung's disease and correlated them with hemodynamic and biochemical parameters. Tumor necrosis factor (TNF-alpha), interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) were measured by ELISA preoperatively, intraoperatively (hourly), and 24 and 48 hours postoperatively. IL-6 levels increased significantly in all cases within 2 hours of commencement of the operation (P less than .01) and were maximal 24 hours postoperatively. No significant changes in IL-1 beta levels (mean range, 70 to 110 pg/mL) were seen in these patients. TNF levels were undetectable (less than 20 pg/mL) throughout the study. Cortisol levels were increased in all patients during operation. Serum C-reactive protein levels were first detected 24 hours postoperatively and continued to increase 48 hours postoperatively. Hemodynamically, heart rate increased during the first 3 hours of operation and correlated with increase in IL-6 levels. Blood pressure and temperature changes did not correlate with cytokine levels. This study identifies IL-6 as the earliest detectable cytokine response associated with major surgery in infants. It also suggests that IL-6 can be unregulated, independently of other cytokines, in response to surgical stress.