Renal function and injury in infants and young children with congenital heart disease

Background

The aim of this study was to investigate renal function and injury in infants and young children with congenital heart disease (CHD).

Methods

We prospectively enrolled 58 CHD children aged ??3?years and 20 age-matched controls and divided these into four groups: Group I, acyanotic CHD (n?=?24); Group II, cyanotic CHD with arterial oxygen saturation of >75?% (n?=?20); Group III, cyanotic CHD with arterial oxygen saturation of ??75?% (n?=?14); Group IV, normal controls (n?=?20). Urinary levels of microalbumin (MA), N-acetyl-?-D-glucosaminidase (NAG), and ??1-microglobulin (??1-MG) corrected by creatinine (UCr) were compared.

Results

Children with CHD had elevated urinary ??1-MG/UCr levels, with Group III children having the highest level. Groups I and III children had higher urinary NAG/UCr levels than those of Groups II and IV. Urinary MA/UCr levels in the three patient groups were comparable and significantly higher than that in the control group. A ??1-MG?×?100/ (??1-MG?+?MA) of <15?%, indicative of glomerular damage, was present in two patients in Group I and one in Group III, but none in Group II.

Conclusions

Tubular injury can occur in CHD patients during infancy and early childhood. Among our patient cohort, it was most prominent in children with severe cyanosis. Glomerular injury was detected in some individuals with advanced heart failure or severe cyanosis.     

Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children

Background. The goal of the study was to determine activatedthrombelastographic (TEG®) parameters with the rotationalTEG® (ROTEG or ROTEM) device (Pentapharm GmbH, Munich, Germany)in neonates and infants <1 yr with complex congenital heartdisease (CCHD) and to compare them with those of healthy children. Methods. A total of 59 children were included: Group I (Gr I)24 children, ASA I, scheduled for minor surgery; and Group II(Gr II) 35 children with CCHD, ASA III–IV, scheduled forcardiac surgery. Each group was subdivided into four age groups.Blood samples were obtained before the surgical procedure. Results. Statistically significant differences (two-way ANOVAanalysis) between Gr I and Gr II [mean (SD); P-value] were foundin INTEG-CT [Gr I 175(19), Gr II 271(162); P=0.049], EXTEG-MCF[Gr I 63(8), Gr II 56(8); P=0.013], EXTEG-MCE [Gr I 186(65),Gr II 137(41); P=0.003], FIBTEG-MCF [Gr I 24(7), Gr II 19(5);P=0.012], FIBTEG-MCE [Gr I 32(13), Gr II 24(8); P=0.012] andEXTEG-MCE–FIBTEG-MCE [Gr I 155(55), Gr II 113(37); P=0.003].Clotting time via contact activation was prolonged in Gr IIand varied widely, mainly in the age group 0–1 month andto a lesser extent in 1–3 months, and maximum clot firmnesswas reduced in the same age groups. In comparison with Gr II,the healthy children showed relatively homogenous TEG valueswith a tendency to hypercoagulability; the maximum was foundin age group 1–3 months, decreasing towards adult valuesin the course of the first year of life. Conclusions. These preliminary TEG results indicate that thecoagulation-fibrinolytic system in CCHD patients <1 yr isfunctionally intact and balanced but at a lower level than inhealthy children. This could be interpreted as a reduction inthe haemostatic potential with less reserve.     

Anticoagulation therapy and the risk of perioperative brain injury in neonates with congenital heart disease

ObjectiveThere is considerable variability in anticoagulation use in neonates with transposition of the great arteries (TGA) and single ventricle physiology (SVP) for secondary stroke prevention and primary cardiovascular indications. Leveraging cross-center differences in anticoagulation use, we compared the risk of new postoperative brain injury in neonates with TGA and SVP treated with anticoagulation relative to untreated neonates.MethodsTwo-center observational cohort study of 118 term-born neonates with TGA (n = 83) and SVP (n = 35), undergoing cardiopulmonary bypass surgery and pre- and postoperative brain magnetic resonance imaging. Anticoagulation and antiplatelet therapy details were obtained. Magnetic resonance images were scored for stroke, white matter injury, and hemorrhage. New postoperative injury was compared between neonates with and without anticoagulation for the 2-center cohort, and subsequently stratified by cardiac lesion type and anticoagulation indication.ResultsThirty-six out of 118 neonates (29%) received anticoagulation: 11 (30%) for preoperative stroke, 20 (56%) for preoperative peripheral/intracardiac thrombus, and 5 (14%) for Blalock-Taussig shunt. Five out of 36 neonates (14%) treated with anticoagulation also received antiplatelet therapy. Although no differences were identified for the 2-center cohort or for neonates with TGA separately, significantly more new postoperative parenchymal brain injury (P = .04), particularly stroke, was found in SVP neonates with compared to without anticoagulation (31% vs 5%). In neonates who experienced preoperative stroke, new subdural hemorrhage (36% vs 0%) was more frequent in neonates treated with anticoagulation therapy compared with those without anticoagulation therapy.ConclusionsIn our cohort of neonates with TGA and SVP, anticoagulation for preoperative stroke, preoperative thrombus, and/or Blalock-Taussig shunt did not have the anticipated benefit of preventing new perioperative brain injury. These findings indicate the critical need for rigorous randomized trials on the safety and effectiveness of anticoagulation therapy in this population.     

体外膜肺支持在新生儿和婴幼儿复杂先天性心脏病术后的应用

目的：总结分析1994年2月至1999年4月，35例复杂先天性心脏病病儿直视手术后行体外膜肺支持的效果。方法：病儿年龄1－820d，中位数19d；体重2．1－14．0kg，中位数3．6kg.采用静脉－动脉转流，流量每分钟100ml/kg,ACT180-200s。结果：体外膜肺支持病例占同期婴幼儿心内直视手术的3．4％，主要指征是术后低心输出量综合征（42．9％），支持时间1－15d，中位数5d。生存21例（60％），晚期生存率49％，保留原体－肺循环分流者生存率高于保留者（80％比0，P＜0．05），虽然具有2个心室病儿有较好的治疗效果（生存率68％），但合并单心室畸形病儿也有40％的生存率，结论：体外膜肺支持是抢救新生儿及婴幼儿心脏手术后危重病例的有效方法。     

先天性心脏病术后患儿肠内营养喂养不耐受管理的最佳证据总结

目的 检索、评价并总结先天性心脏病术后患儿肠内营养喂养不耐受管理的最佳证据,为医护人员开展临床实践提供依据。方法 系统检索国内外循证资源数据库、指南及专业协会网站中涉及先天性心脏病术后患儿肠内营养喂养不耐受管理的文献,检索时限为建库至2023年4月1日。2名经循证训练的研究者对纳入文献进行文献质量评价、证据提取和整合。结果 共纳入15篇文献,包括临床决策1篇,指南3篇,专家共识5篇,系统评价4篇,随机对照研究2篇。从喂养不耐受的评估与监测、营养制剂、喂养方式、症状处理、管理策略5个方面总结24条最佳证据。结论 先天性心脏病术后患儿肠内营养喂养不耐受管理的最佳证据可为进一步加强患儿的营养管理,提高临床护理质量提供循证依据。     

Recent development of congenital heart surgery in neonates and small infants

Cardiac surgery has been developed dramatically during these 50 years since Gross and Lellihei pioneered repair of intracardiac anomalies using cardiopulmonary bypass in mid 1950's. In late 1960's and early 1970's, the technique of deep hypothermia and circulatory arrest (DHCA) has been developed in Japan and Sir Brian Barratt-Boyes in New Zealand used Kyoto technique (DHCA) to repair many infants and small children with complex congenital heart diseases (CHD). The introduction of DHCA was an important development in the history of the treatment of CHD, allowing the approach of previously unrepairable lesions. Open heart surgery in neonates has been adopted worldwide since Castaneda in Boston performed neonatal arterial switch in mid 1980's. Since then, most of our efforts have been led to repair most of the CHD primarily in neonate and small infants. Mortality of open heart surgery in neonates has dropped significantly during recent 10 years and now, more than 95% of the children with CHD survive in Japan. Surgical strategies and results in each CHD were summarized.     

Brain injury in children with congenital heart disease

The incidence of neurodevelopmental impairment in children with congenital heart disease is high. Its aetiology is multiple and complex. Prevention and treatment must start during the preoperative period and continue through the intra- and postoperative periods. Research has resulted in a clearer understanding of the relationship between congenital heart disease and the brain, and of the effects of cardiopulmonary bypass, hypothermia and circulatory arrest. This has led to modifications in management which may improve neurological outcome in the future.     

Transvenous pacing in infants and children with congenital heart disease

A technique for transvenous pacemaker implantation in children with complex heart disease is described. The use of small positive-fixation leads, introducers, retained guidewires, and atrial lead loops to allow for growth all have an important role in management of this often challenging problem.     

婴幼儿复杂先天性心脏病术后机械通气时间延长的危险因素分析

目的探讨婴幼儿复杂先天性心脏病术后机械通气时间延长(prolonged mechanical ventilation,PMV)的危险因素。方法回顾性分析2016年1月至2017年12月北京安贞医院小儿心外科收治的150例复杂先天性心脏病患儿,男80例,女70例,年龄≤6个月,RACHS-1分级≥3级。收集患儿一般资料、相关病史、手术类型、术前合并症及治疗情况、术中心肺转流(cardiopulmonary bypass, CPB)时间、深低温及血气指标;术后延迟关胸、放置起搏器情况;术后24 h内最低OI、最高正性肌力药剂量评分值(VIS评分)、拔管失败及术后并发症情况。采用Logistic回归模型分析婴幼儿复杂先天性心脏病术后PMV的危险因素。结果 42例(28%)患儿存在术后PMV。单因素分析显示,年龄、体重、RACHS-1分级、既往紫绀、既往肺炎、急诊手术、术前机械通气支持、术前射血分数(ejection fraction, EF)、深低温、CPB时间132 min、术中最低pH、术中最高血糖浓度高、术中最高乳酸浓度高、延迟关胸、应用起搏器、术后24 h内最高VIS评分和最低OI及术后并发症是婴幼儿复杂先天性心脏病术后PMV的危险因素(P0.05)。多因素Logistic回归分析显示,CPB时间132 min(OR=11.04,95%CI 2.07～58.96,P=0.005),术中最高乳酸浓度过高(OR=1.53,95%CI 1.07～2.20,P=0.021)和拔管失败(OR=17.28,95%CI 2.46～121.20,P=0.004)是婴幼儿复杂先天性心脏病术后PMV的独立危险因素。结论 CPB时间132 min、术中最高乳酸浓度过高和拔管失败可作为预测婴幼儿复杂先天性心脏病术后PMV的危险因素。     

SIOOB protein and its clinical effect on craniocerebra injury

Objective： To explore the role of S100B protein in the early diagnosis, treatment, and prognosis judgement of craniocerebral injury.
Methods： In this study, we reviewed the domestic and foreign research reports about the relationship between S100B protein and craniocerebral injury.
Results： The concentration of S100B protein had a different increase based on the degree of injury in early stage after craniocerebral injury, and the increasing degree of S100B protein showed a positive correlation with the grading of pathogenetic condition and prognosis of craniocerebral injury.
Conclusions： S100B protein may be taken as a specific index of early diagnosis, grading of pathogenetic condition, and prognosis judgement after craniocerebral injury. To grasp and regulate the mechanism of neurotoxicity and to elucidate the therapeutic effect of S100B protein will be a research direction in clinical treatment of craniocerebral injury.     

Serum levels of S100B,S100A1B and S100BB are all related to outcome after severe traumatic brain injury

Summary Objectives. S100B is an established marker of brain damage. Used in the context as a biochemical marker, S100B denotes a measurement of all S100 proteins, including at least one S100B monomer, i.e. the sum of the two dimers S100A1B and S100BB. Almost all published studies are based on this “sum concentration”. However, the brain specificity of S100B has been questioned and increased serum levels have also been reported after trauma without head injury. Since the S100B monomer dominates in the brain, we hypothesised that the S100BB dimer should be better related to outcome after severe traumatic brain injury than S100A1B or the “sum concentration”. Methods. Daily serum samples were collected from 59 patients with severe traumatic brain injury. Three different ELISA methods were used for measurements of S100B, S100A1B and S100BB respectively. Outcome was assessed after one year and categorised according to the Glasgow Outcome Scale. Results. Serum levels of S100B, S100A1B and S100BB followed the same temporal course, with early maximum and rapidly decreasing values over the first days after the trauma. Maximum serum concentrations of each of the parameters were increased in the patient group with an unfavourable outcome compared with those with a favourable outcome (p = 0.01, 0.006 and 0.004, respectively). Conclusion. Both S100A1B and S100BB were related to outcome after severe traumatic brain injury. Even though this study is small, it seems unlikely that separate analyses of the dimers are of any advantage compared with measuring S100B alone. Correspondence: Dr. Karin Nylén, Department of Neurology, Sahlgrenska University Hospital, SE-413 45 G?teborg, Sweden.