Endotoxin Activity in Neonates Undergoing Cardiac Surgery: Cohort Study

Area of Science:

• Pediatric Cardiac Surgery
• Neonatal Intensive Care
• Sepsis and Endotoxemia Research

Background:

• Endotoxemia in pediatric cardiac surgery patients is not well understood.
• The study aimed to establish reference levels for endotoxin activity assay (EAA) in neonates undergoing cardiac surgery.
• It also investigated associations with pre-, intra-, and postoperative risk factors for gut hypoperfusion and the impact of refeeding on endotoxin levels.

Purpose of the Study:

• To assess endotoxin activity assay (EAA) reference levels in neonates undergoing cardiac surgery.
• To identify pre-, intra-, and postoperative risk factors associated with EAA levels and gut hypoperfusion.
• To determine if refeeding affects endotoxin levels in these patients.

Main Methods:

• A prospective cohort study enrolled neonates undergoing cardiac surgery (correction or palliation).
• Exclusion criteria included preterm birth, weight < 1.5 kg, need for extracorporeal membrane oxygenation, and urgent surgery.
• Endotoxin activity assay (EAA) levels were measured at baseline and postoperatively.

Main Results:

• Endotoxin activity assay (EAA) baseline levels were inversely correlated with age at surgery and increased by postoperative day 2.
• Neither on-pump vs. off-pump surgery nor palliation vs. correction predicted EAA level increases.
• Higher postoperative EAA levels were associated with abdominal distension and feeding intolerance.

Conclusions:

• Endotoxin activity assay (EAA) levels increase following elective neonatal cardiac surgery.
• Refeeding does not significantly alter postoperative endotoxin levels.
• Elevated postoperative EAA levels may serve as a predictor for feeding intolerance in neonates.