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. 2022 Feb 28;11(3):489.
doi: 10.3390/antiox11030489.

Oxidative Stress and Indicators of Brain Damage Following Pediatric Heart Surgery

Débora Cañizo Vázquez  1 , Stephanie M Hadley  2 , Marta Pérez Ordóñez  3 , Miriam Lopez-Abad  1 , Anna Valls  4 , Marta López Viñals  5 , Bosco A Moscoso  6 , Sergio Benito Fernandez  7 , Marta Camprubí-Camprubí  8 , Joan Sanchez-de-Toledo  9
Affiliations

Oxidative Stress and Indicators of Brain Damage Following Pediatric Heart Surgery

Débora Cañizo Vázquez et al. Antioxidants (Basel). .

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.

Keywords: 8-iso-prostaglandin F2α; S100B protein; oxidative stress; pediatric cardiac surgery.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart of patients.
Figure 2
Figure 2
Levels of 8-iso-PGF2α. (A) Evolution of 8-iso-PGF2α in the perioperative period. (B) Levels of 8-iso-PGF2α in the perioperative period considering age group. (C) Evolution of 8-iso-PGF2α in the perioperative period considering the requirement of cardio-pulmonary bypass (CPB) during the surgery (* p = 0.0214).
Figure 3
Figure 3
Levels of S100B protein. (A) Evolution of S100B protein in the perioperative period. (B) Levels of S100B protein depending on the presence of electrical seizures during the surgery.
Figure 4
Figure 4
Correlation between levels of S100B immediately post-surgery and levels of 8-iso-PGF2α 24 h after surgery.
Figure 5
Figure 5
Neurological outcome. (A) Distribution of 8-iso-PGF2 levels 24 h after the surgery considering neurological outcome. (B) Distribution of S100B protein levels 72 h after the surgery considering neurological outcome.
Figure 6
Figure 6
ROC curve for levels of S100B at 72 h.
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