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Effects of cardiopulmonary bypass on neonatal and paediatric inflammatory profiles
S S Ashraf1, Y Tian, S Zacharrias
1Cardiothoracic Department, Killingbeck Hospital, Leeds, UK.
Insights
Neonates exhibit a more pronounced inflammatory response to cardiopulmonary bypass (CPB) than infants, with higher levels of interleukin-8 and interleukin-6. Further research is needed to understand these differences in CPB-related inflammation.
Area of Science:
- Pediatric Cardiology
- Immunology
- Cardiothoracic Surgery
Background:
- Cardiopulmonary bypass (CPB) is associated with significant morbidity in pediatric patients.
- The inflammatory mechanisms underlying CPB-induced capillary leak and edema are not fully understood.
- Little is known about the proinflammatory response to CPB in neonates and infants undergoing early cardiac interventions.
Purpose of the Study:
- To investigate and compare the inflammatory responses to CPB in neonates and infants.
- To elucidate potential differences in the pathophysiology of CPB-related inflammation between these two age groups.
Main Methods:
- A two-group study involving 14 neonates (1-28 days) and 13 infants (2-12 months) undergoing CPB for congenital heart disease.
- Blood samples were collected at multiple time points: pre-anesthesia, during CPB, and up to 24 hours post-protamine administration.
- Plasma levels of cytokines (IL-6, IL-8), terminal complement complex (C5b-9), neutrophil counts, and leucocyte elastase were measured.
Main Results:
- All measured inflammatory markers increased significantly in both groups during and after CPB.
- Interleukin-8 (IL-8) levels were significantly higher in neonates compared to infants post-CPB.
- Interleukin-6 (IL-6) remained elevated at 24 hours post-CPB in neonates, while terminal complement complex (C5b-9) was higher in infants perioperatively.
- Leukocyte elastase profiles did not differ significantly between the two groups.
Conclusions:
- There are discernible differences in the inflammatory response to CPB between neonates and infants.
- Neonatal patients warrant further investigation to understand the distinct pathophysiology and clinical sequelae of CPB-related inflammation.
- These findings highlight the need for age-specific considerations in managing pediatric patients undergoing CPB.
Objective:
Cardiopulmonary bypass (CPB) causes significant morbidity in paediatric patients, yet the mechanisms involved in the related inflammatory processes (resulting in capillary leak and edema) are poorly understood. Moreover, earlier palliative and corrective intervention in neonates and infants has provided the cohorts of patients about whom little is known of their proinflammatory response.
Methods:
In the present two group study, 14 neonates (age 1-28 days, 2.5-4.5 kg) and 13 infants (2-12 months, 3-7 kg), undergoing CPB for congenital heart disease were consecutively recruited. The two cohorts were well matched in terms of CPB and aortic cross-clamp times (P > 0.1). Blood samples were collected on induction of anaesthesia, 5 min following onset of CPB, at the end of CPB, and 30 min, 2 and 24 h post-protamine (PP) administration. Plasma concentration of cytokines interleukin-6 (IL-6) and interleukin-8 (IL-8), terminal complement complex (C5b-9) neutrophil counts and leucocyte elastase were measured.
Results:
Plasma levels of all inflammatory markers significantly increased in both groups during and following CPB as compared to baseline. During and following CPB the change in IL-8 level was more pronounced in neonates (peak 30 min PP, median(range): 1062 (182-3872) pg/ml) than in infants 568 (172-1368) pg/ml), P = 0.01. Changes in IL-6 level were indistinguishable between groups intraoperatively, but remained significantly higher at 24 h in neonates (P = 0.02). Peri and postoperative levels of C5b-9 were significantly higher in infants than in neonates (peak 30 min PP, median (range): 984 (118-1142) ng/ml vs 458 (22 1340) ng/ml in neonates respectively, P = 0.01) but were similar at 24 h. Despite this, leucocyte elastase profiles did not differ significantly between the respective cohorts.
Conclusion:
These results indicate that there may be differences between neonates and infants with regard to the inflammatory response to CPB and neonatal patients merit further investigation in order to elucidate whether the pathophysiology of their CPB related inflammatory response and its clinical sequelae differs from their older counterparts.