The Journal of pediatrics · 2011
Time course of C-reactive protein and inflammatory mediators after neonatal surgery.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Nguyen-Vermillion Annie, Juul Sandra E, McPherson Ronald J, Ledbetter Daniel J
Аннотация
OBJECTIVE: To characterize the perioperative course of C-reactive protein (CRP) and inflammatory mediators in neonates ≤44 weeks' corrected gestational age.
STUDY DESIGN: Prospective study of CRP and inflammatory mediators interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α in 55 neonates undergoing thoracic or abdominal surgery.
RESULTS: In the absence of infection, CRP increased after surgery, peaking on post-operative day 2. The perioperative patterns of CRP differed by diagnosis and inflammatory state. Surgery alone did not cause an increase in CRP because in 13 of 55 infants (24%), CRP remained <1.0 mg/dL at all time points. For thoracic procedures, patent ductus arteriosus ligation showed the least post-operative increase in CRP, and patients undergoing repair of congenital diaphragmatic hernia or tracheoesophageal fistula had a greater response. Abdominal procedures with low CRP response included repair of imperforate anus and pyloric stenosis, while gastroschisis repair and bowel reanastomosis after necrotizing enterocolitis were accompanied by a robust CRP response. IL-6 concentrations peaked on post-operative day 1 and correlated with the post-operative day 2 CRP peak (r=0.398, P=.004). The additional inflammatory mediators measured were not informative.
CONCLUSIONS: The range and time course of perioperative CRP differ by diagnosis. Serial measurements may be more informative than CRP magnitude.
STUDY DESIGN: Prospective study of CRP and inflammatory mediators interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α in 55 neonates undergoing thoracic or abdominal surgery.
RESULTS: In the absence of infection, CRP increased after surgery, peaking on post-operative day 2. The perioperative patterns of CRP differed by diagnosis and inflammatory state. Surgery alone did not cause an increase in CRP because in 13 of 55 infants (24%), CRP remained <1.0 mg/dL at all time points. For thoracic procedures, patent ductus arteriosus ligation showed the least post-operative increase in CRP, and patients undergoing repair of congenital diaphragmatic hernia or tracheoesophageal fistula had a greater response. Abdominal procedures with low CRP response included repair of imperforate anus and pyloric stenosis, while gastroschisis repair and bowel reanastomosis after necrotizing enterocolitis were accompanied by a robust CRP response. IL-6 concentrations peaked on post-operative day 1 and correlated with the post-operative day 2 CRP peak (r=0.398, P=.004). The additional inflammatory mediators measured were not informative.
CONCLUSIONS: The range and time course of perioperative CRP differ by diagnosis. Serial measurements may be more informative than CRP magnitude.
Предметные рубрики MeSH
AbdomenAdrenal Cortex HormonesAmpicillinAnastomosis, SurgicalAnti-Bacterial AgentsC-Reactive ProteinCongenital AbnormalitiesEnterocolitis, NecrotizingHernia, DiaphragmaticHernias, Diaphragmatic, CongenitalHumansInfant, NewbornInterleukinsPostoperative PeriodProspective StudiesThoracic Surgical ProceduresTracheoesophageal FistulaTumor Necrosis Factor-alpha