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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Prevention of infectious complications after heart surgery in children: procalcitonin-guided strategy
Dmitry Popov1, Michail Yaroustovsky1, Galina Lobacheva1
1Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russian Federation.
Insights
Early IgM-enriched intravenous immunoglobulins (IVIGs) significantly reduced infectious complications in children undergoing cardiac surgery. This procalcitonin (PCT)-guided strategy also shortened hospital and ICU stays, offering a promising prevention method.
Area of Science:
- Pediatric Cardiology
- Infectious Disease Management
- Immunotherapy
Background:
- Infectious complications are a major concern in cardiac surgery.
- Effective prevention strategies are needed, particularly after cardiopulmonary bypass (CPB).
- Understanding pathogenesis can guide new therapeutic approaches.
Purpose of the Study:
- To assess the efficacy of a procalcitonin (PCT)-guided strategy using IgM-enriched intravenous immunoglobulins (IVIGs).
- To evaluate the impact on systemic inflammation in pediatric patients with congenital heart disease post-cardiac surgery.
- To determine the effectiveness in preventing early postoperative infectious complications.
Main Methods:
- A prospective randomized clinical trial involving 60 pediatric patients with elevated PCT levels (> 2 ng/mL) post-CPB.
- Patients received either standard treatment or standard treatment plus IgM-enriched IVIGs (Pentaglobin) for three days.
- Outcomes, including infectious complications and length of stay, were compared between groups.
Main Results:
- The IgM-enriched IVIG group showed a significant reduction in infectious complications (3.3% vs. 26.7%, p=0.03).
- Patients receiving IVIGs had shorter hospital stays (19 vs. 24 days, p=0.002).
- Intensive care unit (ICU) stay was also reduced in the IVIG group (3 vs. 4 days, p=0.03).
Conclusions:
- Elevated procalcitonin (PCT) levels post-cardiac surgery indicate a higher risk of infection.
- Early administration of IgM-enriched IVIGs is effective in preventing infectious complications.
- This strategy offers a valuable approach to improve outcomes in pediatric cardiac surgery patients.
Introduction:
Infectious complications remain a significant problem of modern cardiac surgery. New prevention strategies, based on the pathogenesis of such complications occurring after cardiopulmonary bypass (CPB) procedures, should be evaluated.
Aim Of The Study:
To evaluate the effectiveness of a procalcitonin (PCT)-guided strategy involving the use of IgM-enriched intravenous immunoglobulins (IVIGs) in children with congenital heart disease with systemic inflammation during the early postoperative period.
Material And Methods:
Sixty consecutive patients aged 25 (21-30) months who underwent cardiac surgery with CPB and had blood PCT levels > 2 ng/mL on the 1(st) postoperative day were enrolled in this single-center prospective randomized clinical trial. The patients were randomized into two groups, comparable in terms of the severity of their initial condition, age, and CPB time. IgM-enriched IVIGs (Pentaglobin, Biotest Pharma GmbH, Germany) were administered during the first 3 postoperative days (5 mL/kg each day) in the study group (n = 30) in addition to the standard treatment, which was also provided to the control group (n = 30). The data are presented as medians with 25-75(th) percentiles; they were compared by the Mann-Whitney U-test, and p values of < 0.05 were considered as statistically significant.
Results:
Postoperatively, 1/30 (3.3%) patients in the study group and 8/30 (26.7%) in the control group suffered from infectious complications (study group: urinary tract infection [UTI] - 1; control group: pneumonia - 4, pneumonia and sepsis - 2, peritonitis with multiorgan failure - 1, UTI - 1), p = 0.03. The length of hospital stay in the study group was shorter than in the control group: 19 (16-23) days vs. 24 (19-29) days, p = 0.002, as was the length of intensive care unit (ICU) stay: 3 (2-4) days vs. 4 (2-8) days, p = 0.03.
Conclusions:
High PCT levels on the 1st postoperative day are associated with an increased risk of infectious complications after cardiac surgery. Early administration of IgM-enriched IVIGs can prevent the development of infectious complications.
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