1
|
Kesäläinen A, Rantanen R, Honkila M, Helminen M, Rahkonen O, Kallio M, Ruuska T, Kekäläinen E, Heinonen S. 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. BMJ Paediatr Open 2024; 8:e002651. [PMID: 38830724 PMCID: PMC11149146 DOI: 10.1136/bmjpo-2024-002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] 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.
Collapse
Affiliation(s)
- Anssi Kesäläinen
- Translational Immunology Research Program, University of Helsinki Faculty of Medicine, Helsinki, Uusimaa, Finland
| | - Rea Rantanen
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Pohjanmaa, Finland
- Research Unit of Clinical Medicine and Medical Research Centre (MRC), Oulu University Faculty of Medicine, Oulu, Finland
| | - Minna Honkila
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Pohjanmaa, Finland
- Research Unit of Clinical Medicine and Medical Research Centre (MRC), Oulu University Faculty of Medicine, Oulu, Finland
| | - Merja Helminen
- Department of Paediatrics, Tampere University Hospital, Tampere, Pirkanmaa, Finland
| | - Otto Rahkonen
- Department of Paediatric Cardiology, New Children's Hospital, Helsinki, Uusimaa, Finland
| | - Merja Kallio
- Research Unit of Clinical Medicine and Medical Research Centre (MRC), Oulu University Faculty of Medicine, Oulu, Finland
- Department of Paediatric Cardiology, New Children's Hospital, Helsinki, Uusimaa, Finland
| | - Terhi Ruuska
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Pohjanmaa, Finland
- Research Unit of Clinical Medicine and Medical Research Centre (MRC), Oulu University Faculty of Medicine, Oulu, Finland
- University of Oulu Biocenter, Oulu, Finland
| | - Eliisa Kekäläinen
- Translational Immunology Research Program, University of Helsinki Faculty of Medicine, Helsinki, Uusimaa, Finland
- HUS Diagnostic Center Clinical Microbiology, Helsinki University Central Hospital, Helsinki, Uusimaa, Finland
| | - Santtu Heinonen
- Paediatric Research Center, New Children's Hospital, Helsinki, Uusimaa, Finland
| |
Collapse
|
2
|
Abstract
Breast feeding has been associated with improved infant outcomes in multiple aspects, including immune outcomes such as infections and potentially atopy and autoimmunity. However associations do not necessarily implicate cause and effect and at this point, exactly how breast feeding and components of breast milk may modulate the infant's immune compartment remains unclear, especially in humans. Some lines of evidence suggest that breastfeeding affects the development of the infant's thymus, a critical organ for T cell development. This may be a direct effect mediated by breast milk components or alternatively, a secondary effect from the impact of breast feeding on the infant's gut microbiome. Here we discuss the potential mechanisms and impact of this association between breast feeding and thymic development.
Collapse
Affiliation(s)
- Peter S Hsu
- Allergy and Immunology, Kids Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Ralph Nanan
- Charles Perkins Centre Nepean, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
3
|
Morsheimer MM, Rychik J, Forbes L, Dodds K, Goldberg DJ, Sullivan K, Heimall JR. Risk Factors and Clinical Significance of Lymphopenia in Survivors of the Fontan Procedure for Single-Ventricle Congenital Cardiac Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:491-6. [DOI: 10.1016/j.jaip.2015.11.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/15/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
|