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Perioperative Immunoglobulin Dynamics and Infection Risk in Infants Undergoing Congenital Heart Surgery: A
Zhiye Yao1,2, Yuxiong Guo2,3, Yumei Liu1,2
1Department of Neonatal Intensive Care Unit (NICU), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Insights
Infant heart surgery can lower immunoglobulin G (IgG) levels, increasing infection risk. Monitoring IgG levels after congenital heart disease (CHD) surgery may help identify infants needing treatment.
Area of Science:
- Pediatric Cardiology
- Immunology
- Surgical Critical Care
Background:
- Infants with congenital heart disease (CHD) often require surgery within the first year of life.
- CHD surgery triggers systemic inflammation and hemodilution, potentially depleting circulating immunoglobulins (Ig).
Purpose of the Study:
- To quantify immunoglobulin levels (IgG, IgA, IgM) in infants undergoing CHD surgery.
- To assess the association between immunoglobulin depletion, cardiopulmonary bypass (CPB) characteristics, and clinical outcomes, including post-operative infections.
Main Methods:
- Prospective observational cohort study of 300 infants (<12 months) undergoing CHD surgery.
- Quantification of IgG, IgA, and IgM at four peri-operative time-points.
- Analysis using multivariable logistic and linear models to determine predictors of infection and Ig depletion.
Main Results:
- Mean IgG decreased by 23% 24 hours post-surgery, with longer CPB duration correlating with greater IgG decline.
- Post-operative infection occurred in 17% of infants and was linked to lower IgG levels and prolonged ICU stay.
- Lower baseline IgG, longer CPB time, lower gestational age, and higher surgical complexity independently predicted infection.
Conclusions:
- Significant early post-operative IgG depletion is associated with increased infection risk and ICU utilization following infant CHD surgery.
- Peri-operative immunoglobulin monitoring can aid in risk stratification and identify candidates for immunoglobulin-based interventions.
Background:
Infants with congenital heart disease (CHD) frequently undergo surgery during their first year of life. Infants undergoing CHD surgery experience systemic inflammation and hemodilution that can deplete circulating immunoglobulins (Ig).
Methods:
In this prospective single-center observational cohort study without healthy controls, we quantified IgG, IgA, and IgM at four perioperative time points (T0 = preoperative; T1 = 24 h; T2 = 72 h; T3 = day 7) in 300 infants (<12 months), including 280 with cardiopulmonary bypass (CPB) and 20 without CPB. Postoperative infections were defined using Centers for Disease Control and Prevention/National Healthcare Safety Network cardiothoracic criteria. Multivariable logistic and linear models assessed associations between Ig depletion, CPB characteristics, and clinical outcomes.
Results:
Mean IgG fell 23% at T1 (910 ± 160→700 ± 140 mg/dL, P < 0.001) and partially recovered by T3. Longer CPB was independently related to larger IgG decline ( β = 2.5% per 10 min, P < 0.001; R ² = 0.14). Infection occurred in 17% of infants and was associated with lower IgG at T1 (650 ± 135 vs. 725 ± 140 mg/dL, P < 0.001) and prolonged intensive care unit stay (median: 7 vs. 5 days, P < 0.01). Baseline IgG < 900 mg/dL (adjusted odds ratio [aOR]: 2.1), CPB > 120 min (aOR: 2.5), gestation < 37 weeks (aOR: 1.9), and surgical complexity (Risk Adjustment for Congenital Heart Surgery category ≥3; aOR: 1.8) independently predicted infection.
Conclusions:
Substantial early postoperative IgG depletion correlates with infection risk and intensive care unit utilization after infant CHD surgery. Routine perioperative Ig monitoring may help stratify risk and identify candidates for Ig-based interventions.
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