Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.

<h4>Introduction</h4>Cardiac surgery (CS) in pediatric patients induces an overt oxidative stress (OS) response. Children are particularly vulnerable to OS related injury. The immaturity of their organs and antioxidant systems as well as the induction of OS in cardio-pulmonary bypass (CP...

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Autores principales:	Stephanie Hadley, Debora Cañizo Vazquez, Miriam Lopez Abad, Stefano Congiu, Dmytro Lushchencov, Marta Camprubí Camprubí, Joan Sanchez-de-Toledo
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b45c771efaf14c1690bb5533fa7a888a
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spelling	oai:doaj.org-article:b45c771efaf14c1690bb5533fa7a888a2021-12-02T20:05:12ZOxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.1932-620310.1371/journal.pone.0250124https://doaj.org/article/b45c771efaf14c1690bb5533fa7a888a2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0250124https://doaj.org/toc/1932-6203<h4>Introduction</h4>Cardiac surgery (CS) in pediatric patients induces an overt oxidative stress (OS) response. Children are particularly vulnerable to OS related injury. The immaturity of their organs and antioxidant systems as well as the induction of OS in cardio-pulmonary bypass (CPB) surgery may have an important impact on outcomes. The purpose of this study was to describe the OS response, measured by urinary free 8-iso-PGF2α, in infants undergoing CS and to evaluate the relationship between OS response and post-operative clinical outcomes.<h4>Methods</h4>Infants with congenital heart disease undergoing CS with or without CPB were eligible for enrollment. Children were classified as neonates (<30 days) or infants (30 days-6 months) based on the age at surgery. Perioperative continuous non-invasive neuromonitoring included amplitude-integrated electroencephalogram and cerebral regional oxygen saturation measured with near-infrared spectroscopy. Urine 8-iso-PGF2α levels were measured before, immediately post-, and 24-hours post-surgery, and the 8-iso-PGF2 clearance was calculated.<h4>Results</h4>Sixty-two patients (60% neonates) were included. Urine 8-iso-PGF2α levels 24 hours after surgery (8.04 [6.4-10.3] ng/mg Cr) were higher than pre-operative levels (5.7 [4.65-7.58] ng/mg Cr) (p<0.001). Those patients with a severe degree of cyanosis caused by Transposition of the Great Arteries (TGA) had the highest post-operative 8-iso-PGF2α levels. Patients with intra-operative seizures had higher post-operative 8-iso-PGF2α levels. 8-iso-PGF2α clearance at 24 hours post-surgery was different between newborns and infant patients, and it was inversely correlated with days of mechanical ventilation (p = 0.05), ICU LOS (p = 0.05) and VIS score at 24 hours (p = 0.036).<h4>Conclusions</h4>Children undergoing CS, particularly neonatal patients, experience a significant post-operative OS response that might play an important role in postoperative morbidity. TGA patients undergoing arterial switch operations demonstrate the highest post-operative OS response. Rapid clearance of isoprostanes, which occurs more frequently in older patients with more mature antioxidant systems, might be associated with better clinical outcomes.Stephanie HadleyDebora Cañizo VazquezMiriam Lopez AbadStefano CongiuDmytro LushchencovMarta Camprubí CamprubíJoan Sanchez-de-ToledoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0250124 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stephanie Hadley Debora Cañizo Vazquez Miriam Lopez Abad Stefano Congiu Dmytro Lushchencov Marta Camprubí Camprubí Joan Sanchez-de-Toledo Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.
description	<h4>Introduction</h4>Cardiac surgery (CS) in pediatric patients induces an overt oxidative stress (OS) response. Children are particularly vulnerable to OS related injury. The immaturity of their organs and antioxidant systems as well as the induction of OS in cardio-pulmonary bypass (CPB) surgery may have an important impact on outcomes. The purpose of this study was to describe the OS response, measured by urinary free 8-iso-PGF2α, in infants undergoing CS and to evaluate the relationship between OS response and post-operative clinical outcomes.<h4>Methods</h4>Infants with congenital heart disease undergoing CS with or without CPB were eligible for enrollment. Children were classified as neonates (<30 days) or infants (30 days-6 months) based on the age at surgery. Perioperative continuous non-invasive neuromonitoring included amplitude-integrated electroencephalogram and cerebral regional oxygen saturation measured with near-infrared spectroscopy. Urine 8-iso-PGF2α levels were measured before, immediately post-, and 24-hours post-surgery, and the 8-iso-PGF2 clearance was calculated.<h4>Results</h4>Sixty-two patients (60% neonates) were included. Urine 8-iso-PGF2α levels 24 hours after surgery (8.04 [6.4-10.3] ng/mg Cr) were higher than pre-operative levels (5.7 [4.65-7.58] ng/mg Cr) (p<0.001). Those patients with a severe degree of cyanosis caused by Transposition of the Great Arteries (TGA) had the highest post-operative 8-iso-PGF2α levels. Patients with intra-operative seizures had higher post-operative 8-iso-PGF2α levels. 8-iso-PGF2α clearance at 24 hours post-surgery was different between newborns and infant patients, and it was inversely correlated with days of mechanical ventilation (p = 0.05), ICU LOS (p = 0.05) and VIS score at 24 hours (p = 0.036).<h4>Conclusions</h4>Children undergoing CS, particularly neonatal patients, experience a significant post-operative OS response that might play an important role in postoperative morbidity. TGA patients undergoing arterial switch operations demonstrate the highest post-operative OS response. Rapid clearance of isoprostanes, which occurs more frequently in older patients with more mature antioxidant systems, might be associated with better clinical outcomes.
format	article
author	Stephanie Hadley Debora Cañizo Vazquez Miriam Lopez Abad Stefano Congiu Dmytro Lushchencov Marta Camprubí Camprubí Joan Sanchez-de-Toledo
author_facet	Stephanie Hadley Debora Cañizo Vazquez Miriam Lopez Abad Stefano Congiu Dmytro Lushchencov Marta Camprubí Camprubí Joan Sanchez-de-Toledo
author_sort	Stephanie Hadley
title	Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.
title_short	Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.
title_full	Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.
title_fullStr	Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.
title_full_unstemmed	Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.
title_sort	oxidative stress response in children undergoing cardiac surgery: utility of the clearance of isoprostanes.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/b45c771efaf14c1690bb5533fa7a888a
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Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes.

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