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White Matter Injury and the Inflammatory Response Following Neonatal Cardiac Surgery

Pediatric Cardiology volume 36, pages 942–949 (2015)Cite this 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.

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Fig. 1

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

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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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Affiliations

  1. Division of Neuroradiology, Department of Radiology and Imaging Sciences, Children’s Healthcare of Atlanta, Emory University School of Medicine, 1364 Clifton Rd. NE, EUH B115, Atlanta, GA, 30322, USA

    Nilesh K. Desai

  2. Division of Neonatology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA

    Shannon E. G. Hamrick

  3. Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Matthew J. Strickland & Emilia Matthews

  4. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Laura McMaster

  5. Division of Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA

    William T. Mahle

Authors
  1. Nilesh K. Desai
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  2. Shannon E. G. Hamrick
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  3. Matthew J. Strickland
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  4. Emilia Matthews
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  5. Laura McMaster
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  6. William T. Mahle
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Correspondence to Nilesh K. Desai.

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Desai, N.K., Hamrick, S.E.G., Strickland, M.J. et al. White Matter Injury and the Inflammatory Response Following Neonatal Cardiac Surgery. Pediatr Cardiol 36, 942–949 (2015). https://doi.org/10.1007/s00246-015-1104-x

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  • DOI: https://doi.org/10.1007/s00246-015-1104-x

Keywords

  • Congenital heart disease
  • MRI
  • Periventricular leukomalacia