Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun 3;8(1):e002651.
doi: 10.1136/bmjpo-2024-002651.

Effects of antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability following paediatric open-heart surgery and thymectomy: a single-centre retrospective cohort study

Anssi Kesäläinen  1 , Rea Rantanen  2   3 , Minna Honkila  2   3 , Merja Helminen  4 , Otto Rahkonen  5 , Merja Kallio  3   5 , Terhi Ruuska  2   3   6 , Eliisa Kekäläinen  7   8 , Santtu Heinonen  9
Affiliations

Effects of antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability following paediatric open-heart surgery and thymectomy: a single-centre retrospective cohort study

Anssi Kesäläinen et al. BMJ Paediatr Open. .

Abstract

Background: Partial or complete thymectomy is routinely performed in paediatric open-heart surgeries when treating congenital heart defects. Whether or not thymectomised children require systematic immunological monitoring later in life is unknown. The objective of this study was to investigate the effects of preoperatively and postoperatively used antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability in paediatric patients with early thymectomy to better recognise the patients who could benefit from immunological follow-up in the future.

Methods: We conducted a retrospective cohort study, including 98 children and adolescents aged 1-15 years, who had undergone an open-heart surgery and thymectomy in infancy and who had previously answered a survey regarding different immune-mediated symptoms and diagnoses. We performed a comprehensive chart review of preoperative and postoperative factors from 1 year preceding and 1 year following the open-heart surgery and compared the participants who had self-reported symptoms of immunological vulnerability to those who had not.

Results: The median age at primary open-heart surgery and thymectomy was 19.5 days in the overall study population (60% men, n=56) and thymectomies mainly partial (80%, n=78). Broad-spectrum antibiotics were more frequently used preoperatively in participants with self-reported immunological vulnerability (OR=3.05; 95% CI 1.01 to 9.23). This group also had greater overall use of antibiotics postoperatively (OR=3.21; 95% CI 1.33 to 7.76). These findings were more pronounced in the subgroup of neonatally operated children. There was no statistically significant difference in the duration of intensive care unit stay, hospitalisation time, prevalence of severe infections, surgical complications or glucocorticoid use between the main study groups.

Conclusion: Antimicrobial agents were more frequently used both preoperatively and postoperatively in thymectomised children with self-reported immunological vulnerability after thymectomy. Substantial use of antimicrobial agents early in life should be considered a potential risk factor for increased immunological vulnerability when evaluating the significance of immune-mediated symptom occurrence in thymectomised paediatric patients.

Keywords: Cardiology; Child Health; Microbiology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: No, there are no competing interests.

Figures

Figure 1
Figure 1
Flowchart of patient selection and grouping. CHD, congenital heart defect.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Yekeler E, Tambag A, Tunaci A, et al. . Analysis of the thymus in 151 healthy infants from 0 to 2 years of age. J Ultrasound Med 2004;23:1321–6. 10.7863/jum.2004.23.10.1321 - DOI - PubMed
    1. Cavalcanti NV, Palmeira P, Jatene MB, et al. . Early Thymectomy is associated with long-term impairment of the immune system: A systematic review. Front Immunol 2021;12:774780. 10.3389/fimmu.2021.774780 - DOI - PMC - PubMed
    1. Kurobe H, Tominaga T, Sugano M, et al. . Complete but not partial Thymectomy in early infancy reduces T-cell-mediated immune response: three-year tracing study after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2013;145:656–62. 10.1016/j.jtcvs.2012.12.015 - DOI - PubMed
    1. Gudmundsdottir J, Óskarsdóttir S, Skogberg G, et al. . Early Thymectomy leads to premature immunologic ageing: an 18-year follow-up. J Allergy Clin Immunol 2016;138:1439–43. 10.1016/j.jaci.2016.05.014 - DOI - PubMed
    1. van Gent R, Schadenberg AWL, Otto SA, et al. . Long-term restoration of the human T-cell compartment after Thymectomy during infancy: a role for Thymic regeneration Blood 2011;118:627–34. 10.1182/blood-2011-03-341396 - DOI - PubMed

Substances