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Postoperative S100B protein levels as a measure for predicting neurological deficit in children undergoing cardiac

Evyatar Hubara1, Lital Kalich Philosoph2, Simon Lassman3

  • 1Pediatric Cardiac Intensive Care Unit (PCICU), Edmond and Lily Safra Children's Hospital, Sheb, Ramat Gan, Israel.

Frontiers in Cardiovascular Medicine
|June 24, 2026
PubMed

Insights

Post-cardiac surgery brain injury in infants can be predicted using S100B protein levels. Elevated S100B levels six hours after surgery accurately identify new neurological deficits (NND) in infants.

Area of Science:

  • Neuroscience
  • Biomarkers
  • Pediatric Cardiology

Background:

  • Congenital heart surgery poses a risk of brain injury, leading to long-term neurodevelopmental deficits in infants.
  • Early identification of central nervous system injury is crucial for timely neuroprotective interventions.
  • The calcium-binding protein S100B has been linked to poor neurological outcomes in retrospective studies, suggesting its potential as a biomarker.

Purpose of the Study:

  • To prospectively investigate the predictive value of S100B as a biomarker for new neurological deficits (NND) in infants undergoing congenital heart surgery.
  • To determine the optimal diagnostic cut-off value for S100B levels in predicting NND.
  • To assess the utility of S100B in clinical decision-making for post-surgical care.

Main Methods:

  • A prospective cohort of 130 infants undergoing congenital heart surgery was studied.
  • S100B levels were measured before (S100B1) and six hours after surgery (S100B2), normalized by age (z-scores).
  • Neurological function was assessed using the Pediatric Stroke Outcome Measure (PSOM) pre-surgery and at discharge; a ≥1 point increase defined NND. ROC analysis was used for predictive performance evaluation.

Main Results:

  • The S100B2 z-score demonstrated high predictive value for NND, with 93% sensitivity and 85% specificity.
  • A threshold of two standard deviations for S100B2 z-score provided the best diagnostic accuracy.
  • In multivariate analysis, the S100B2 z-score was the strongest independent predictor of NND.

Conclusions:

  • Age-normalized S100B levels measured six hours post-surgery can effectively identify or exclude early brain injury leading to NND in infants.
  • S100B serves as a reliable biomarker for predicting neurological deficits after congenital heart surgery.
  • These findings support the integration of S100B monitoring into post-surgical clinical decision-making protocols.

Keywords:
S100Bbiomarkerbraincongenital-heart-defectinjuryneurology

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