S100B and its relation to cerebral oxygenation in neonates and infants undergoing surgery for congenital heart disease

Abstract

Objectives: Neonates and infants undergoing surgery for congenital heart disease are at risk for developmental impairment. Hypoxic-ischemic brain injury might be one contributing factor. We aimed to investigate the perioperative release of the astrocyte protein S100B and its relation to cerebral oxygenation.Methods: Serum S100B was measured before and 0, 12, 24, and 48 hours after surgery. Cerebral oxygen saturation was derived by near-infrared spectroscopy. S100B reference values based on preoperative samples; concentrations above the 75th percentile were defined as elevated. Patients with elevated S100B at 24 or 48 hours were compared to cases with S100B in the normal range. Neonates (≤28 days) and infants (>28 and ≤365 days) were analyzed separately due to age-dependent release of S100B.Results: Seventy-four patients underwent 94 surgical procedures (neonates, n = 38;infants, n = 56). S100B concentrations were higher in neonates before and after surgery at all time points (P ≤ .015). Highest values were noticed immediately after surgery. Postoperative S100B was elevated after 15 (40.5%) surgeries in neonates.There was no difference in pre-, intra-, or postoperative cerebral oxygenation. In infants, postoperative S100B was elevated after 23 (41.8%) procedures. Preoperative cerebral oxygen saturations tended to be lower (53 ± 12% vs 59 ± 12%, P = .069) and arterial-cerebral oxygen saturation difference was higher (35 ± 11% vs 28 ± 11%, P = .018) in infants with elevated postoperative S100B. In the early postoperative course, cerebral oxygen saturation was lower (54 ± 13% vs 63 ± 12%, P = .011) and arterial-cerebral oxygen saturation difference was wider (38 ± 11% vs 30 ± 10%, P = .008). Cerebral oxygen saturation was also lower for the entire postoperative course (62 ± 18% vs 67 ± 9%, P = .047). Conclusions:Postoperative S100B was elevated in about 40% of neonates and infants undergoing cardiac surgery. Infants with elevated postoperative S100B had impaired perioperative cerebral tissue oxygenation. No relation between S100B and cerebral oxygenation could be demonstrated in neonates. K E Y W O R D Sbrain biomarkers, cardiopulmonary bypass, cerebral protection, near-infrared spectroscopy

Serum Markers of Brain Injury in Pediatric Patients with Congenital Heart Defects Undergoing Cardiac Surgery: Diagnostic and Prognostic Role

“…In our study, we have identified statistically significantly increased values of S100B postoperatively with no correlation between cerebral oxygen saturation or neurodevelopmental scores and S100B. As Hansen et al showed in a study, postoperative levels of S100B were increased in about 40% of newborns and children with CHD [31]. Increased S100B values after surgery in children with CHD have been associated with neurological impairment [9,11,38].…”

“…Children with increased postoperative S100B levels also had impaired perioperative cerebral tissue oxygenation. In newborns, no relationship was found between S100B and cerebral oxygenation [31].…”

“…GFAP is a constituent part of the astrocyte cytoskeleton, and it is released into the peripheral circulation after brain injury, such as traumatic brain injury, stroke, and cardiac arrest [30]. Increased levels of GFAP have been associated with changes in the white matter on magnetic resonance imaging (MRI) and impaired psychomotor development in neonates with HIE [31]. Regarding the relationship between our study's GFAP level and developmental score, the results showed a good predicting model in the cyanotic CHD group to be used as a predictor of neurological impairment.…”

The top-100 most cited articles of biomarkers in congenital heart disease: a bibliometric analysis

“…The following biomarkers are being focused on: matrix metalloproteinases (MMPs), transforming growth factor β (TGF-β), tissue inhibitors of matrix metalloproteinases (TIMPs), alpha1antitrypsin, as well as non-coding microRNAs (47,48). Cluster III represented biomarkers in secondary injury after cardiopulmonary bypass in children with CHD, such as Neutrophil gelatinase-associated lipocalin (NGAL) and SB100 protein, which mainly involved the prediction and evaluation of kidney injury and brain injury after extracorporeal circulation (49,50). The concentration of NGAL in urine and serum represents a sensitive, specific and highly predictive early biomarker of acute kidney injury after cardiac surgery.…”