Cortisol Response in Children After Second Cardiopulmonary Bypass

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Harish Bangalore1, Paul A Checchia1, Elena C Ocampo2

  • 1Department of Pediatrics, Section of Critical Care, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St. Suite W6006, Houston, TX, 77030, USA.

Pediatric Cardiology
|September 1, 2018
PubMed

Insights

Children undergoing a second heart surgery with cardiopulmonary bypass (CPB) show a reduced cortisol stress response. This suggests a blunted hormonal reaction to repeated CPB exposure in pediatric patients.

Area of Science:

  • Pediatric Cardiology
  • Endocrinology
  • Surgical Stress Response

Background:

  • Cardiopulmonary bypass (CPB) surgery in children is associated with a significant surge in cortisol levels.
  • Previous research indicates that repeated stress can attenuate the cortisol response.

Purpose of the Study:

  • To investigate whether a second exposure to CPB in children results in a diminished cortisol increase compared to the first exposure.
  • To test the hypothesis of a reduced cortisol response to repeated CPB stress.

Main Methods:

  • Serial serum cortisol levels were measured in 46 children at three time points (day 0, 1, and 2) after each of two CPB surgeries.
  • Statistical analysis involved log-transformation and adjustment for the time interval between surgeries.

Main Results:

  • Cortisol levels were significantly lower after the second CPB surgery compared to the first.
  • Specifically, cortisol levels were 42% lower on day 0 (p=0.02) and 46% lower on day 2 (p=0.02) after the second surgery.
  • The mean age at first surgery was 3.5 months and at second surgery was 10.4 months.

Conclusions:

  • A second exposure to CPB in children with congenital heart disease is associated with an attenuated cortisol release.
  • This finding supports the concept of stress response attenuation following repeated exposure to CPB in pediatric surgical patients.

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