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Detection of Alpha II-Spectrin Breakdown Products in the Serum of Neonates With Congenital Heart Disease*

Jain, Parag MD1; Spaeder, Michael C. MD1; Donofrio, Mary T. MD2; Sinha, Pranava MD3; Jonas, Richard A. MD3; Levy, Richard J. MD4

Pediatric Critical Care Medicine: March 2014 - Volume 15 - Issue 3 - p 229–235
doi: 10.1097/PCC.0000000000000059
Cardiac Intensive Care

Objectives: To determine if alpha II-spectrin breakdown products can be detected in the serum of neonates with congenital heart disease in the perioperative period.

Design: Prospective observational cohort study.

Setting: Pediatric cardiac ICU in an urban tertiary care academic center.

Patients: Neonates with congenital heart disease undergoing surgical repair or palliation.

Interventions: Serial blood sampling for measurement of 120 and 150 kDa spectrin breakdown products.

Measurements and Main Results: Fourteen neonates with congenital heart disease undergoing cardiac surgery were evaluated. Nine infants underwent open-heart surgery and five underwent closed-heart surgery. Serum spectrin breakdown products were measured with sandwich enzyme-linked immunosorbent assay preoperatively and then 6, 24, 48, 72, and 96 hours following surgery. Brain imaging was obtained as part of routine clinical care in 12 patients preoperatively and six patients postoperatively. Six patients had normal preoperative imaging (three closed-heart surgery and three open-heart surgery), whereas six had evidence of neurologic injury prior to surgery (one closed-heart surgery and five open-heart surgery). Only one patient had a postoperative imaging study that lacked injury. All others demonstrated infarction or hemorrhage. Spectrin breakdown product 120 kDa significantly increased 24 hours after open-heart surgery compared to preoperative values and time-matched closed-heart surgery levels. Spectrin breakdown product 150 kDa significantly increased 6 hours after open-heart surgery compared to preoperative values. There was no significant change in spectrin breakdown products following closed-heart surgery. Peak spectrin breakdown products significantly increased following open-heart surgery compared to closed-heart surgery.

Conclusions: Spectrin breakdown products can be detected in the serum of neonates with congenital heart disease in the perioperative period and levels increased to a greater degree in infants following open-heart surgery. These findings suggest that, in future work, serum spectrin breakdown products may potentially be developed as biomarkers for brain necrosis and apoptosis in infants with congenital heart disease.

1Division of Critical Care Medicine, Children’s National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC.

2Division of Cardiology, Children’s National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC.

3Division of Cardiovascular Surgery, Children’s National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC.

4Division of Anesthesiology and Pain Medicine, Children’s National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC.

* See also p. 270.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Levy is supported by Children’s National Medical Center Institutional Bridge Fund. Dr. Spaeder received support for travel from the National Center for the Study of Preparedness and Catastrophic Event Response and from the Society of Critical Care Medicine. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: rlevy@cnmc.org

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies