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A Novel Brain Injury Biomarker Correlates with Cyanosis in Infants with Congenital Heart Disease

Authors
  • McPhillips, Lindsey1, 2
  • Kholwadwala, Dipak1, 2
  • Sison, Cristina P.2, 3
  • Gruber, Dorota1, 2
  • Ojamaa, Kaie1, 2, 4
  • 1 Cohen Children’s Medical Center of New York at Northwell Health, Division of Pediatric Cardiology, Department of Pediatrics, New Hyde Park, NY, 11040, USA , New Hyde Park (United States)
  • 2 Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA , Hempstead (United States)
  • 3 The Feinstein Institute for Medical Research, Northwell Health, Biostatistics Unit, Manhasset, NY, 11030, USA , Manhasset (United States)
  • 4 New York Institute of Technology College of Osteopathic Medicine, Department of Biomedical Sciences, Old Westbury, NY, 11568, USA , Old Westbury (United States)
Type
Published Article
Journal
Pediatric Cardiology
Publisher
Springer-Verlag
Publication Date
Nov 14, 2018
Volume
40
Issue
3
Pages
546–553
Identifiers
DOI: 10.1007/s00246-018-2023-4
Source
Springer Nature
Keywords
License
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Abstract

Cyanotic heart lesions are a complex subset of congenital heart disease (CHD) in which patients are desaturated until surgical repair or palliation. We hypothesized that a direct relationship would exist between degree of desaturation and presence of systemic inflammation and brain injury in unrepaired patients less than 1 year of age. The pre-operative desaturation with augmented systemic inflammation would predict a more complex post-operative course. Fifty patients with CHD were enrolled in this study and classified as cyanotic (O2 ≤ 90%) or acyanotic (O2 > 90%) based on SpO2. Serum inflammatory mediators measured included interleukins (IL)-6, IL-8, IL-12p70, IL-10, IL-1β, tumor necrosis factor (TNF)-α, interferon (INF)-γ; macrophage inhibitory factor (MIF) and a novel brain biomarker, phosphorylated neurofilament heavy subunit (pNF-H). Twenty-two cyanotic and 28 acyanotic subjects were enrolled with SpO2 of 78 ± 18% and 98 ± 2% (p < 0.001), respectively, and mean age of 72 days (range 2–303) and 102 days (range 1–274), respectively. Cyanotic vs acyanotic subjects had elevated serum IL-6 (6.6 ± 7.6 vs 2.9 ± 2.9 pg/ml, p = 0.019) and pNF-H (222 ± 637 vs 57 ± 121 pg/ml, p = 0.046), and both biomarkers correlated with degree of desaturation (Spearman rank-order correlation ρ = − 0.30, p = 0.037 and ρ = − 0.29 p = 0.049, respectively). Post-operative inotrope scores at 24 h and duration of mechanical ventilation correlated inversely with pre-operative oxygen saturation (ρ = − 0.380, p = 0.014 and ρ = − 0.362, p = 0.020, respectively). The degree of pre-operative desaturation correlated with a more complicated post-operative course supporting the need for advanced peri-operative therapy in this population.

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