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Camprubí-Camprubí M, Sanchez-de-Toledo J. Editorial: Cardiac outflow tract development and diseases. Front Pediatr 2023; 11:1323167. [PMID: 38027277 PMCID: PMC10666748 DOI: 10.3389/fped.2023.1323167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Marta Camprubí-Camprubí
- Department of Neonatology, Hospital Sant Joan de Déu, Barcelona, Spain
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
- Department of Pediatric Cardiology, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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2
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Cañizo-Vazquez D, Hadley S, Leonhardt M, Camprubí-Camprubí M, Sanchez-de-Toledo J. Early post-operative neurodevelopment and visual assessment in neonates with congenital heart disease undergoing cardiac surgery. J Perinatol 2023; 43:856-863. [PMID: 36347968 DOI: 10.1038/s41372-022-01555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Assessment of neurobehavior and visual function of newborns with congenital heart disease during the post-operative period to identify infants at risk of neurodevelopmental and visual impairment. STUDY DESIGN Prospective study that included 45 newborns who underwent cardiac surgery. Newborn Behavioral Observations test (NBO) and "ML Battery of Optotypes" were used for assessment. RESULTS The median NBO global score was 2.4 [2.1-2.6]. Total days of oral morphine [p = 0.005] and total days of sedation [p = 0.009] were strongly related to abnormal evaluations. Time of cerebral regional oxygen saturation (CrSO2) under 40% during surgery and increased lactate were related to abnormal motor evaluation. Only 14.5% of patients presented pathological results in visual evaluation. CONCLUSIONS We have demonstrated alterations in attention, autonomic, motor, and oral motor function. Duration of sedative medication, time of CrSO2 under 40% during surgery, and increased lactate are the most important risk factors. No significant visual impairment was detected.
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Affiliation(s)
- D Cañizo-Vazquez
- BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - S Hadley
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - M Leonhardt
- BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Camprubí-Camprubí
- BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain.
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain.
| | - J Sanchez-de-Toledo
- Cardiovascular Research Group, Sant Joan de Déu Research Institute, Barcelona, Spain
- Pediatric Cardiology Department. Sant Joan de Déu Hospital, Barcelona, Spain
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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3
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Ball M, Benito S, Caride JP, Ruiz-Herguido C, Camprubí-Camprubí M, Sanchez-de-Toledo J. Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation after Prolonged Circulatory Arrest. J Vis Exp 2023. [PMID: 37306433 DOI: 10.3791/65266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Congenital heart disease (CHD) is the most prevalent congenital malformation, with about one million births impacted worldwide per year. Comprehensive investigation of this disease requires appropriate and validated animal models. Piglets are commonly used for translational research due to their analogous anatomy and physiology. This work aimed to describe and validate a neonatal piglet model of cardiopulmonary bypass (CPB) with circulatory and cardiac arrest (CA) as a tool for studying severe brain damage and other complications of cardiac surgery. In addition to including a list of materials, this work provides a roadmap for other investigators to plan and execute this protocol. After experienced practitioners performed several trials, the representative results of the model demonstrated a 92% success rate, with failures attributed to small piglet size and variant vessel anatomy. Furthermore, the model allowed practitioners to select from a wide variety of experimental conditions, including varying times in CA, temperature alterations, and pharmacologic interventions. In summary, this method uses materials readily available in most hospital settings, is reliable and reproducible, and can be widely employed to enhance translational research in children undergoing heart surgery.
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Affiliation(s)
- Madeleine Ball
- Sant Joan de Déu Research Institute; Vanderbilt University School of Medicine, Vanderbilt University
| | - Sergio Benito
- Sant Joan de Déu Research Institute; Department of Pediatric Critical Care Medicine, Sant Joan de Déu Hospital
| | | | | | - Marta Camprubí-Camprubí
- Sant Joan de Déu Research Institute; BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Sant Joan de Déu Hospital;
| | - Joan Sanchez-de-Toledo
- Sant Joan de Déu Research Institute; Department of Pediatric Cardiology, Sant Joan de Déu Hospital; Department of Critical Care Medicine, University of Pittsburgh
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Cañizo Vázquez D, Hadley SM, Pérez Ordóñez M, Lopez-Abad M, Valls A, Viñals ML, Moscoso BA, Benito Fernandez S, Camprubí-Camprubí M, Sanchez-de-Toledo J. Oxidative Stress and Indicators of Brain Damage Following Pediatric Heart Surgery. Antioxidants (Basel) 2022; 11:antiox11030489. [PMID: 35326139 PMCID: PMC8944849 DOI: 10.3390/antiox11030489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 01/27/2023] Open
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.
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Affiliation(s)
- Débora Cañizo Vázquez
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain; (D.C.V.); (M.L.-A.)
| | - Stephanie M. Hadley
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Marta Pérez Ordóñez
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Cardiovascular Research Group, Sant Joan de Deu Research Institute, 08950 Barcelona, Spain;
| | - Miriam Lopez-Abad
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain; (D.C.V.); (M.L.-A.)
| | - Anna Valls
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Marta López Viñals
- Department of Anesthesia, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Bosco A. Moscoso
- Department of Cardiothoracic Surgery, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Sergio Benito Fernandez
- Department of Pediatric Critical Care, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Marta Camprubí-Camprubí
- Cardiovascular Research Group, Sant Joan de Deu Research Institute, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain
- Correspondence:
| | - Joan Sanchez-de-Toledo
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
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Cascant-Vilaplana MM, Albiach-Delgado A, Camprubí-Camprubí M, Pérez-Cruz M, Gómez O, Arráez M, López-Nogueroles M, Kuligowski J, Vento M. A UPLC-MS/MS method for the determination of oxidative stress biomarkers in amniotic fluid. Free Radic Biol Med 2022; 179:164-169. [PMID: 34971756 DOI: 10.1016/j.freeradbiomed.2021.12.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 12/31/2022]
Abstract
Oxidative stress in the fetal period is associated with preterm birth as well as short and long-term adverse clinical outcomes. Here, an Ultra-Performance Liquid Chromatography-tandem Mass Spectrometry (UPLC-MS/MS) method for the simultaneous quantification of biomarkers of oxidative stress-derived damage to proteins and DNA in amniotic fluid (AF) samples is presented. Appropriate accuracy and precision levels, as well as sensitivity with limits of detection in the low nanomolar (<2 nM) range were achieved. The analytical method was applied to a set of AF samples and reference ranges of the biomarker panel are presented. Median concentrations of biomarkers of protein oxidation (ortho-, 3-chloro-, and 3-nitrotyrosine) and their precursors (para-tyrosine and phenylalanine) ranged between 0.6 and 3 nM and 23 and 30 μM, respectively, while levels of a biomarker of DNA-oxidation (8-hydroxydeoxyguanosine, 8OHdG) and its precursor (2'-deoxyguanosine) were found to be 0.18 and 3 nM, respectively. Detection frequencies of all metabolites were 100% with exception of 3-chlorotyrosine (3Cl-Tyr) and 8OHdG, that were only detected in 8% of samples. The developed method may be applied in research studies focusing on oxidative stress-related complications during pregnancy.
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Affiliation(s)
| | | | - Marta Camprubí-Camprubí
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Miriam Pérez-Cruz
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Olga Gómez
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Miguel Arráez
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.
| | - Máximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain; Division of Neonatology, University & Polytechnic Hospital La Fe, Valencia, Spain.
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Escobar-Diaz MC, Pérez-Cruz M, Arráez M, Cascant-Vilaplana MM, Albiach-Delgado A, Kuligowski J, Vento M, Masoller N, Gómez-Roig MD, Gómez O, Sanchez-de-Toledo J, Camprubí-Camprubí M. Brain Oxygen Perfusion and Oxidative Stress Biomarkers in Fetuses with Congenital Heart Disease - A Retrospective, Case-Control Pilot Study. Antioxidants (Basel) 2022; 11:antiox11020299. [PMID: 35204182 PMCID: PMC8868271 DOI: 10.3390/antiox11020299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/05/2023] Open
Abstract
Fetuses with congenital heart disease (CHD) have circulatory changes that may lead to predictable blood flow disturbances that may affect normal brain development. Hypoxemia and hypoperfusion may alter the redox balance leading to oxidative stress (OS), that can be assessed measuring stable end-products. OS biomarkers (OSB) were measured in amniotic fluid in fetuses with (n = 41) and without CHD (n = 44) and analyzed according to aortic flow, expected cyanosis after birth, and a CHD classification derived from this. Birth head circumference (HC) was used as a neurodevelopment biomarker. CHD fetuses had higher levels of ortho-Tyrosine (o-Tyr) than controls (p = 0.0003). There were no differences in o-Tyr levels considering aortic flow obstruction (p = 0.617). Fetuses with expected extreme cyanosis presented the highest levels of o-Tyr (p = 0.003). Among groups of CHD, fetuses without aortic obstruction and extreme cyanosis had the highest levels of o-Tyr (p = 0.005). CHD patients had lower HC than controls (p = 0.023), without correlation with OSB. Patients with HC < 10th percentile, presented high levels of o-Tyr (p = 0.024). Fetuses with CHD showed increased OSB and lower HC when compared to controls, especially those with expected extreme cyanosis. Our results suggest that increased levels of OSB are more influenced by the effect of low oxygenation than by aortic flow obstruction. Future studies with larger sample size are needed to further investigate the role of OSB as an early predictor of neurodevelopmental problems in CHD survivors.
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Affiliation(s)
- Maria C. Escobar-Diaz
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (M.C.E.-D.); (J.S.-d.-T.)
- Sant Joan de Deu Research Institute, 08950 Barcelona, Spain; (M.A.); (M.D.G.-R.)
| | - Miriam Pérez-Cruz
- Sant Joan de Deu Research Institute, 08950 Barcelona, Spain; (M.A.); (M.D.G.-R.)
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (N.M.); (O.G.)
- Maternal and Child Health and Development Network II (SAMID II), Instituto de Salud Carlos III (ISCIII), Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), 28029 Madrid, Spain
- Correspondence: (M.P.-C.); (M.C.-C.); Tel.: +34-60-723-1455 (M.P.-C.); +34-65-904-5406 (M.C.-C.)
| | - Miguel Arráez
- Sant Joan de Deu Research Institute, 08950 Barcelona, Spain; (M.A.); (M.D.G.-R.)
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (N.M.); (O.G.)
| | - Mari-Merce Cascant-Vilaplana
- Neonatal Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.-M.C.-V.); (A.A.-D.); (J.K.); (M.V.)
| | - Abel Albiach-Delgado
- Neonatal Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.-M.C.-V.); (A.A.-D.); (J.K.); (M.V.)
| | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.-M.C.-V.); (A.A.-D.); (J.K.); (M.V.)
| | - Máximo Vento
- Neonatal Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.-M.C.-V.); (A.A.-D.); (J.K.); (M.V.)
- Division of Neonatology, University & Polytechnic Hospital La Fe, 46026 Valencia, Spain
| | - Narcis Masoller
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (N.M.); (O.G.)
- Institut d’Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 08036 Barcelona, Spain
| | - Maria Dolores Gómez-Roig
- Sant Joan de Deu Research Institute, 08950 Barcelona, Spain; (M.A.); (M.D.G.-R.)
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (N.M.); (O.G.)
- Maternal and Child Health and Development Network II (SAMID II), Instituto de Salud Carlos III (ISCIII), Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), 28029 Madrid, Spain
| | - Olga Gómez
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (N.M.); (O.G.)
- Institut d’Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 08036 Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (M.C.E.-D.); (J.S.-d.-T.)
- Sant Joan de Deu Research Institute, 08950 Barcelona, Spain; (M.A.); (M.D.G.-R.)
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marta Camprubí-Camprubí
- Sant Joan de Deu Research Institute, 08950 Barcelona, Spain; (M.A.); (M.D.G.-R.)
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (N.M.); (O.G.)
- Correspondence: (M.P.-C.); (M.C.-C.); Tel.: +34-60-723-1455 (M.P.-C.); +34-65-904-5406 (M.C.-C.)
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Benito S, Hadley S, Camprubí-Camprubí M, Sanchez-de-Toledo J. Blind Endotracheal Intubation in Neonatal Rabbits. J Vis Exp 2021. [PMID: 33720117 DOI: 10.3791/61874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical characteristics, which is further complicated in the case of the newborn. Of the different methods of advanced airway management, endotracheal intubation is less aggressive than tracheostomy, and is more feasible than supraglottic management given the lack of supraglottic devices of such a small size. As direct glottis visualization is very difficult in animals this size, this blind intubation model is presented as an effective alternative, especially for experiments requiring prolonged anesthesia. Using this method, we performed blind intubations with a 90% success rate.
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Affiliation(s)
- Sergio Benito
- Department of Pediatric Critical Care, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu
| | | | - Marta Camprubí-Camprubí
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona
| | - Joan Sanchez-de-Toledo
- Department of Pediatric Cardiology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu; Department of Critical Care Medicine, University of Pittsburgh;
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Bell JL, Saenz L, Domnina Y, Baust T, Panigrahy A, Bell MJ, Camprubí-Camprubí M, Sanchez-de-Toledo J. Acute Neurologic Injury in Children Admitted to the Cardiac Intensive Care Unit. Ann Thorac Surg 2019; 107:1831-1837. [PMID: 30682351 DOI: 10.1016/j.athoracsur.2018.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 11/20/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children with acquired and congenital heart disease both have low mortality but an increased risk of neurologic morbidity that is multifactorial. Our hypothesis was that acute neurologic injuries contribute to mortality in such children and are an important cause of death. METHODS All admissions to the pediatric cardiac intensive care unit (CICU) from January 2011 through January 2015 were retrospectively reviewed. Patients were assessed for any acute neurologic events (ANEs) during admission, as defined by radiologic findings or seizures documented on an electroencephalogram. RESULTS Of the 1,573 children admitted to the CICU, the incidence of ANEs was 8.6%. Mortality of the ANE group was 16.3% compared with 1.5% for those who did not have an ANE. The odds ratio for death with ANEs was 8.55 (95% confidence interval, 4.56 to 16.03). Patients with ANEs had a longer hospital length of stay than those without ANEs (41.4 ± 4 vs 14.2 ± 0.6 days; p < 0.001). Need for extracorporeal membrane oxygenation, previous cardiac arrest, and prematurity were independently associated with the presence of an ANE. CONCLUSIONS Neurologic injuries are common in pediatric CICUs and are associated with an increase in mortality and hospital length of stay. Children admitted to the CICU are likely to benefit from improved surveillance and neuroprotective strategies to prevent neurologic death.
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Affiliation(s)
- Jamie L Bell
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Lucas Saenz
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuliya Domnina
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracy Baust
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael J Bell
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's National Medical Center and the George Washington University School of Medicine, Washington, DC
| | - Marta Camprubí-Camprubí
- Department of Neonatology, Hospital Sant Joan de Déu, Barcelona University, Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiology, Hospital Sant Joan de Déu, Barcelona University, Barcelona, Spain.
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