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Remote Ischemic Preconditioning Does Not Prevent White Matter Injury in Neonates
J William Gaynor1, Susan C Nicolson2, Diane M Spray1
1Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
The Annals of Thoracic Surgery
|March 31, 2018
Summary
Remote ischemic preconditioning (RIPC) did not show neuroprotective effects in neonates undergoing cardiac surgery. White matter injury (WMI) assessments revealed no significant difference between RIPC and sham groups in this clinical trial.
Area of Science:
- Neurology
- Cardiology
- Pediatrics
Background:
- Remote ischemic preconditioning (RIPC) is a protective mechanism against ischemia-reperfusion injury.
- Investigated the potential neuroprotective effects of RIPC in neonates undergoing cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of RIPC in preventing white matter injury (WMI) in neonates during cardiac surgery.
Main Methods:
- A randomized, blinded clinical trial involving 67 neonates undergoing cardiac surgery.
- Patients were assigned to either RIPC or a SHAM procedure before cardiopulmonary bypass.
- White matter injury (WMI) was assessed using serial brain MRI to measure changes in WMI volume.
Main Results:
- WMI was present in 28% preoperatively and increased to 62% postoperatively across all patients.
- No significant difference in the prevalence or mean change in WMI volume was observed between the RIPC (600 mL³) and SHAM (107 mL³) groups.
- Baseline and operative characteristics were similar between the groups.
Conclusions:
- This study found no evidence that RIPC confers neuroprotection in neonates undergoing cardiac repair with cardiopulmonary bypass.
- RIPC was not effective in reducing white matter injury in this vulnerable population.
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