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Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass
Kevin Plumpton1, Nikolaus A Haas
1Pediatric Intensive Care Unit, Queensland Center for Congenital Heart Disease, Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia. Nikolaus_Haas@ health.qld.gov.au
Insights
Tri-iodothyronine (T3) replacement may benefit infants undergoing congenital heart surgery. Longer cardiopulmonary bypass (CPB) times and ventilation indicate higher risk for thyroid hormone suppression, suggesting T3 therapy may be beneficial in select infants.
Area of Science:
- Pediatric Cardiology
- Endocrinology
- Cardiothoracic Surgery
Background:
- The clinical utility of tri-iodothyronine (T3) replacement after congenital heart surgery with cardiopulmonary bypass (CPB) remains unclear in unselected pediatric populations.
- Infants experiencing significant thyroid hormone suppression or prolonged recovery post-CPB may potentially benefit from T3 supplementation.
- Identifying infants at risk for marked thyroid hormone suppression is crucial for targeted T3 therapy.
Purpose of the Study:
- To investigate the relationship between organ support parameters during CPB and post-operative thyroid hormone levels in infants.
- To identify infants at risk of significant thyroid hormone suppression following congenital heart surgery.
Main Methods:
- Prospective observational study conducted at a tertiary referral center specializing in congenital heart surgery.
- 36 infants under 12 months of age were enrolled post-CPB.
- Free T3 and thyroid-stimulating hormone levels were measured on ICU admission and post-operative days 1 and 2.
Main Results:
- Increased CPB duration correlated with decreased admission levels of free T3 and thyroid-stimulating hormone.
- Younger and smaller infants exhibited lower admission free T3 levels.
- Infants requiring ventilation at 48 hours post-ICU admission had significantly lower mean free T3 levels on post-operative day 2.
Conclusions:
- Longer CPB times ( > 120 minutes) in infants undergoing congenital heart surgery are associated with suppressed thyroid hormone levels.
- Younger infants (< 3 months) with longer CPB times are identified as a high-risk group for thyroid hormone suppression.
- Further prospective studies evaluating T3 replacement in selected young infants with prolonged CPB are warranted.
Objective:
The clinical benefit of tri-iodothyrinone (T(3)) replacement following congenital heart surgery with cardiopulmonary bypass (CPB) is not clear in unselected cohorts of children. Infants with more marked thyroid hormone suppression or prolonged post-CPB recovery may benefit from T(3) replacement. This study aimed to identify infants at risk of more marked suppression by examining the relationship between organ support parameters during CPB and post-operative thyroid hormone levels.
Design And Setting:
Prospective observational study in a tertiary referral centre for congenital heart surgery.
Patients:
36 infants less than 12 months of age were recruited following CPB.
Measurements And Results:
Thyroid hormone levels were measured on admission to the intensive care unit and on post-operative days 1 and 2. Increasing CPB time was associated with decreasing admission free T(3) and thyroid-stimulating hormone. Younger, smaller infants had lower admission levels of free T(3) on univariant analysis. Infants who continued to require ventilation 48 h after admission to the ICU had a mean free T(3) level on post-operative day 2 that was 0.9 pmol/l lower than in those who had been extubated.
Conclusions:
Prospective studies of T(3) replacement in selected young infants (less than 3 months) with long CPB time (greater than 120 min) during congenital heart surgery are warranted.
