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Influence of operations with cardiopulmonary bypass on polymorphonuclear leukocyte function in infants
Insights
Cardiopulmonary bypass surgery in infants impairs polymorphonuclear leukocyte bactericidal capacity and reduces complement levels. These immune function changes persist for at least 48 hours post-operation.
Area of Science:
- Immunology
- Pediatric Surgery
- Cardiovascular Surgery
Background:
- Congenital heart disease repair often necessitates cardiopulmonary bypass (CPB).
- The impact of CPB on infant immune function requires detailed investigation.
Purpose of the Study:
- To assess the effects of CPB on polymorphonuclear leukocyte (PMN) function in infants.
- To evaluate changes in the immunologic profile, including complement levels, following CPB.
Main Methods:
- Studied 16 infants undergoing congenital heart lesion repair with CPB.
- Analyzed PMN function (chemotaxis, migration, phagocytosis, bactericidal capacity).
- Measured serum opsonizing capacity and complement factors (C3, C4, total hemolytic complement).
Main Results:
- Absolute neutrophil count increased post-CPB.
- PMN bactericidal capacity significantly decreased immediately and 48 hours after CPB.
- Complement factors C3 and C4, and total hemolytic complement decreased post-CPB.
- Serum opsonizing capacity showed variable alterations.
Conclusions:
- CPB significantly impairs PMN bactericidal function in infants.
- CPB leads to complement consumption, affecting the infant immune response.
- These immunologic alterations highlight potential risks associated with CPB in pediatric cardiac surgery.
Abstract:
To determine the effect of operations with cardiopulmonary bypass on the immunologic function of polymorphonuclear leukocytes in infants, we studied polymorphonuclear leukocyte function and immunologic profile in 16 infants undergoing repair of congenital heart lesions. An oxygen/air/high-dose fentanyl anesthetic was used for all patients. Absolute neutrophil count increased significantly (p less than 0.05) after bypass and remained increased 48 hours afterward. Chemotaxis, random migration of polymorphonuclear leukocytes, and phagocytic index were unaffected, but bactericidal capacity decreased significantly immediately after cardiopulmonary bypass and remained decreased 48 hours later. Serum opsonizing capacity to bacterial and fungal antigens was variably altered, and complement factors 3 and 4 decreased significantly after cardiopulmonary bypass. Total hemolytic complement decreased significantly immediately after cardiopulmonary bypass and returned to normal by 48 hours. These data suggest that operations with cardiopulmonary bypass in infants significantly affect the immunologic function of polymorphonuclear leukocytes and result in consumption of complement.