Comparison of Profiles of Perioperative Serum C-Reactive Protein Levels in Neonates Undergoing the Norwood Procedure or Arterial Switch Operation

Dhillon, Santokh; Yu, Xiaoyang; Cheypesh, Andriy; Li, Jia

doi:10.1111/chd.12195

Cited by 6 publications

(8 citation statements)

References 31 publications

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“…A total of 21 studies were included in the pooled analyses. 5,[15][16][17][18][19][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Data were collected for the following timepoints: pre-CPB, end of CPB, 1 h after CPB, POD 1, POD 2, POD 3, POD 4, and POD 5. Figure 1 outlines the study search strategy while Table 1 provides an overview of included studies.…”

Section: Resultsmentioning

confidence: 99%

“…A systemic inflammatory response is a known cause of cardiovascular and pulmonary dysfunction 21,23 . It can be multifactorial in origin and may be triggered during CHS with CPB due to blood contact with foreign surfaces, presence of endotoxemia and development of ischemia and reperfusion injury 24,34,36 . However, the leading cause of systemic inflammatory response after CPB is the interaction of blood components with artificial surfaces of the extracorporeal circuit 24 .…”

Section: Discussionmentioning

confidence: 99%

“…24,34,36 However, the leading cause of systemic inflammatory response after CPB is the interaction of blood components with artificial surfaces of the extracorporeal circuit. 24 Contact of blood with the extracorporeal circuit and reperfusion injury to the lung after declamping are known to trigger intrinsic and extrinsic coagulation. 6 Endotoxemia induced by CPB has been demonstrated in several studies by increased concentrations of lipopolysaccharide in plasma during CPB.…”

Section: Discussionmentioning

confidence: 99%

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C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Farias

Villarreal

Dhargalkar

et al. 2021

Journal of Cardiac Surgery

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Introduction To assess the efficacy of C‐reactive protein (CRP) and procalcitonin (PCT) at identifying infection in children after congenital heart surgery (CHS) with cardiopulmonary bypass (CPB). Materials and Methods Systematic review of the literature was conducted to identify studies with data regarding CRP and/or PCT after CHS with CPB. The primary variables identified to be characterized were CRP and PCT at different timepoints. The main inclusion criteria were children who underwent CHS with CPB. Subset analyses for those with and without documented infection were conducted in similar fashion. A p value of less than .05 was considered statistically significant. Results A total of 21 studies were included for CRP with 1655 patients and a total of 9 studies were included for PCT with 882 patients. CRP peaked on postoperative Day 2. A significant difference was noted in those with infection only on postoperative Day 4 with a level of 53.60 mg/L in those with documented infection versus 29.68 mg/L in those without. PCT peaked on postoperative Day 2. A significant difference was noted in those with infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in those with documented infection versus 5.6 ng/ml in those without. Conclusions Both CRP and PCT increase after CHS with CPB and peak on postoperative day 2. PCT has a greater statistically significant difference in those with documented infection when compared to CRP and a PCT of greater than 5.6 ng/ml should raise suspicion for infection.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Farias

Villarreal

Dhargalkar

et al. 2021

Journal of Cardiac Surgery

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“…The paediatric literature on the kinetics of PCT and CRP in the post-operative period is primarily focused on the postneonatal age group or patients undergoing cardiac surgery. [3][4][5][6][7][8][9][10][11] There are scarce data on PCT or CRP among neonates undergoing non-cardiac surgery. Celik et al showed that CRP concentrations on post-operative days (PODs) 2, 4 and 6 were significantly higher than baseline after neonatal abdominal surgery.…”

Section: What This Paper Addsmentioning

confidence: 99%

Procalcitonin and C‐reactive protein for diagnosing post‐operative sepsis in neonates

Rao

Dutta

Menon

et al. 2021

J Paediatrics Child Health

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Aim: To determine whether serum procalcitonin (PCT) or C-reactive protein (CRP) can diagnose post-operative sepsis among neonates undergoing major non-cardiac surgery. Methods: In this diagnostic study, we included neonates who underwent major non-cardiac surgery and were monitored for post-operative sepsis. We excluded pre-existing septic, inflammatory or life-threatening conditions. Subjects either had 'definite' (culture-positive, n = 14), 'probable' (clinical sepsis, culture-negative, n = 25) or no sepsis (n = 31). We measured serum CRP and PCT at 48 AE 6 h, 72 AE 6 h and 96 AE 6 h postoperatively and compared 'definite or probable sepsis' with 'no sepsis'. Results: Median (Q1, Q3) CRP (mg/L) in 'definite or probable' sepsis group was higher than 'no sepsis' at 72 h (91.48 (57.87, 143.50) vs. 51.32 (33.0, 80.1); P = 0.009) and 96 h (87.51 (45.19, 128.22) vs. 31.00 (25.3, 45.2); P < 0.001). Median (Q1, Q3) PCT (ng/mL) in 'definite or probable' sepsis was higher than 'no sepsis' at 72 h (4.22 (2.04, 12.73) vs. 1.78 (0.9, 6.4); P = 0.01) and 96 h (3.54 (1.96, 9.65) vs. 0.97 (0.4, 3.0); P < 0.001). Ninety-six-hour CRP and PCT cut-offs (based on Youden's index) were 74.16 mg/L and 1.65 ng/mL, respectively. If both CRP and PCT were positive, specificity was 100% (95% confidence interval: 88.78-100). If either one was positive, sensitivity was 88.89% (95% confidence interval: 73.94-96.89). Conclusions: Septic neonates have significantly higher serum CRP and PCT compared to non-septic neonates at 72 and 96 h post-operatively. If both CRP and PCT are positive at 96 h after surgery, it has 100% specificity, and if either one is positive, 89% sensitivity.

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“…9 However, serial levels (which provide the ''CRP velocity'') may differentiate postoperative infection, 10 and CRP may become elevated in certain subpopulations such as postoperative Norwood patient. 11 Interestingly, one study of patients after the Norwood procedure found a correlation between elevated serial CRP measurements and impaired neurocognitive development at age two. 12 Similarly, CD64 has been evaluated as a biomarker of infection.…”

Section: Fever In the Pediatric Cicumentioning

confidence: 99%

Immunologic and Infectious Diseases in Pediatric Cardiac Critical Care

Axelrod

Alten

Berger

et al. 2015

World J Pediatr Congenit Heart Surg

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Since the inception of the Pediatric Cardiac Intensive Care Society (PCICS) in 2003, remarkable advances in the care of children with critical cardiac disease have been developed. Specialized surgical approaches, anesthesiology practices, and intensive care management have all contributed to improved outcomes. However, significant morbidity often results from immunologic or infectious disease in the perioperative period or during a medical intensive care unit admission. The immunologic or infectious illness may lead to fever, which requires the attention and resources of the cardiac intensivist. Frequently, cardiopulmonary bypass leads to an inflammatory state that may present hemodynamic challenges or complicate postoperative care. However, inflammation unchecked by a compensatory anti-inflammatory response may also contribute to the development of capillary leak and lead to a complicated intensive care unit course. Any patient admitted to the intensive care unit is at risk for a hospital acquired infection, and no patients are at greater risk than the child treated with mechanical circulatory support. In summary, the prevention, diagnosis, and management of immunologic and infectious diseases in the pediatric cardiac intensive care unit is of paramount importance for the clinician. This review from the tenth PCICS International Conference will summarize the current knowledge in this important aspect of our field.

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Comparison of Profiles of Perioperative Serum C-Reactive Protein Levels in Neonates Undergoing the Norwood Procedure or Arterial Switch Operation

Cited by 6 publications

References 31 publications

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Procalcitonin and C‐reactive protein for diagnosing post‐operative sepsis in neonates

Immunologic and Infectious Diseases in Pediatric Cardiac Critical Care

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