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Pediatric Cardiology

, Volume 36, Issue 5, pp 942–949 | Cite as

White Matter Injury and the Inflammatory Response Following Neonatal Cardiac Surgery

  • Nilesh K. DesaiEmail author
  • Shannon E. G. Hamrick
  • Matthew J. Strickland
  • Emilia Matthews
  • Laura McMaster
  • William T. Mahle
Original Article

Abstract

White matter injury (WMI) is a known complication following neonatal heart surgery in term infants. In preterm infants, WMI has been associated with the degree of systemic inflammation. It is not known whether inflammation is an important mechanism of WMI as documented by magnetic resonance imaging (MRI) following neonatal heart surgery with cardiopulmonary bypass. Term neonates with congenital heart disease were enrolled in a prospective study with postoperative MRI. White matter injury was recorded by the number of T1 hyperintense foci with >5 foci consistent with significant WMI. Eleven candidate cytokine markers (INF-gamma, TNF-alpha, IL-1 beta, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, and IL-13) were assayed preoperatively and daily for 5 days following surgery. Multiple clinical factors were recorded and correlated with WMI. Ninety-two subjects were enrolled in the study. The median age at surgery was 5 days (interquartile range 4–7 days). Compared with the presurgery level, there were statistically significant increases (p < 0.005) for 8 out of 11 inflammatory markers. In all, 64 postoperative MRIs were performed. No significant correlation was detected between WMI and clinical variables or inflammatory markers assessed immediately postoperative and on postoperative days 1 and 3, with exception of IL-1 beta on postoperative day 1. WMI correlates poorly with the systemic inflammatory response after congenital heart surgery and a number of herein measured clinical factors. WMI following neonatal heart surgery is a complex, still incompletely understood phenomenon that warrants continued investigation.

Keywords

Congenital heart disease MRI Periventricular leukomalacia 

Abbreviations

AP

Aortopulmonary

CICU

Cardiac intensive care unit

CPB

Cardiopulmonary bypass

CHD

Congenital heart disease

DORV

Double-outlet right ventricle

DILV

Double-inlet left ventricle

HLHS

Hypoplastic left heart syndrome

ICU

Intensive care unit

IAA

Interrupted aortic arch

MRI

Magnetic resonance imaging

TAPVR

Total anomalous pulmonary venous return

TA

Truncus arteriosus

WMI

White matter injury

VSD

Ventricular septal defect

Notes

Conflict of interest

This study was funded by the Thrasher Research Foundation #6064. The Thrasher Research Foundation was involved in study design, but not in the collection, analysis, and interpretation of data, writing of the report, or decision to submit the manuscript for publication. The initial draft was created by Nilesh K. Desai, MD and William T. Mahle, MD without any form of payment to produce the manuscript. Nilesh K. Desai, MD and William T. Mahle, MD received salary support from the Thrasher Research Foundation Fund Award 02830-7. Nilesh K. Desai also receives 1 % salary support from Siemens Medical, USA. The authors report no other significant conflict of interest that pertains to this submission.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Nilesh K. Desai
    • 1
    Email author
  • Shannon E. G. Hamrick
    • 2
  • Matthew J. Strickland
    • 3
  • Emilia Matthews
    • 3
  • Laura McMaster
    • 4
  • William T. Mahle
    • 5
  1. 1.Division of Neuroradiology, Department of Radiology and Imaging SciencesChildren’s Healthcare of Atlanta, Emory University School of MedicineAtlantaUSA
  2. 2.Division of Neonatology, Department of PediatricsChildren’s Healthcare of Atlanta, Emory University School of MedicineAtlantaUSA
  3. 3.Department of Environmental HealthEmory University Rollins School of Public HealthAtlantaUSA
  4. 4.Children’s Healthcare of AtlantaAtlantaUSA
  5. 5.Division of Cardiology, Department of PediatricsChildren’s Healthcare of Atlanta, Emory University School of MedicineAtlantaUSA

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