Oxidative Stress and Indicators of Brain Damage Following Pediatric Heart Surgery

Abstract

Pediatric cardiac surgery induces an increased oxidative stress (OS) response. Increased OS is associated with poor neurologic outcomes in neonatal populations with similar patterns of brain injury. We investigated OS and brain injury in infants undergoing heart surgery. Patients 6 months or younger, undergoing cardiac surgery with or without cardiopulmonary bypass (CPB), were included in this prospective, observational study. Patients were divided into infant (30 days–6 months) and neonatal (<30 days) groups for analysis. Urine OS biomarker 8-iso-prostaglandin F2α (8-iso-PGF2α) was quantified pre-surgery and at 0 and 24 h post-surgery. A serum brain damage biomarker S100B protein was also measured pre-surgery and at 0 and 72 h post-surgery. Amplitude-integrated electroencephalography during surgery was analyzed. Neuropsychological evaluation using the Bayley III or Vineland test was performed in all patients at 24 months of age. Sixty-two patients were included, 44 of whom underwent follow-up neurologic evaluation. 8-iso-PGF2α and S100B levels were increased after surgery. Postoperative levels of S100B were positively correlated with 8-iso-PGF2α levels 24 h after surgery (rho = 0.5224; p = 0.0261). There was also a correlation between immediate post-surgery levels of 8-iso-PGF2α and intra-surgery seizure burden (rho = 0.4285, p = 0.0205). Patients with an abnormal neurological evaluation had increased levels of S100B 72 h after surgery (p = 0.048). 8-iso-PGF2α levels 24 h after surgery were also related to abnormal neurologic outcomes. Levels of 8-iso-PGF2α following pediatric cardiac surgery are associated with several indicators of brain injury including brain damage biomarkers, intra-operative seizures, and abnormal neurological evaluation at follow-up, suggesting the importance of oxidative stress response in the origin of brain damage in this population.

Electrical impedance tomography provides information of brain injury during total aortic arch replacement through its correlation with relative difference of neurological biomarkers

“…In a randomized clinical trial, the results showed that for patients with brain injury, the serum S100B increased during CPB with a peak plasma concentration at the termination of CPB and gradually decreased after 24 hours 30 . In our study, compared to patients without PND, PND (+) patients had an increasing of S100B serum level after TAAR with a peak concentration right after surgery and returned to normal level 24–48 h after surgery, which was consistent with previous studies (Tables S7 , S8 ) 30 , 31 . TAU protein is a microtuble-associated protein found in neurons and is a biomarker for neurodegeneration 32 , 33 .…”

“…4 ). Since serum level S100B arrived at peak value around 24 h after cardiac surgery 30 , 31 (Table S7 ), we believed that these three EIT parameters along with S100B had great potential for giving information of neurological damage during surgery for patients with an abnormal preoperative neurological function. Additionally, EIT parameters ΔARV HCA , k HCA and TARV HP had great correlation with variation of serum TAU concentration right after surgery for patients with an abnormal serum level before surgery (Fig.…”

Early versus late parenteral nutrition in term and late preterm infants: a randomised controlled trial

“…52 Recent studies found that increased F 2 -isoprostane levels, an indicator of oxidative stress, 49 are associated with adverse clinical outcomes. [53][54][55] To build evidence in this area, we conducted an exploratory RCT to compare biochemical parameters between early versus late PN in term and late preterm infants. We hypothesised that late commencement of PN will achieve lower (and more physiological) levels of plasma phenylalanine and plasma F 2 -isoprostanes on day 4 and day 8 compared with early commencement of PN in term and late preterm infants.…”

“…Recent studies found that increased F 2 -isoprostane levels, an indicator of oxidative stress, 49 are associated with adverse clinical outcomes. 53–55 …”