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This Article Full Text Full Text (PDF) Supplemental Data All Versions of this Article: clinchem.2007.087700v1 54/1/202    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Florio, P. Articles by Gazzolo, D. Search for Related Content PubMed PubMed Citation Articles by Florio, P. Articles by Gazzolo, D.

Adrenomedullin Blood Concentrations in Infants Subjected to Cardiopulmonary Bypass: Correlation with Monitoring Parameters and Prediction of Poor Neurological Outcome

¹ Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Siena, Italy;² Department of Cardiac Surgery, S. Donato Milanese University Hospital, S. Donato Milanese, Italy;³ Laboratory of Perinatal Medicine and Molecular Biology and Department of Internal Medicine, University "La Sapienza", Rome, Italy;⁴ Department of Pediatric Intensive Care, Hesperia Hospital, Modena, Italy;⁵ Department of Pediatrics and Neuroscience, G. Gaslini Children’s Hospital, University of Genoa, Genoa, Italy; and⁶ Department of Fetal, Maternal, and Neonatal Health, G. Garibaldi Hospital, Catania, Italy

^aaddress correspondence to this author at: Department of Maternal Fetal and Neonatal Health, G. Garibaldi Hospital, Via Palermo 636, I-95100 Catania, Italy. e-mail dgazzolo{at}hotmail.com.

Abstract

Background: Brain injury is a major adverse event after cardiac surgery, especially when extracorporeal circuits are used. We evaluated whether cardiopulmonary bypass (CPB) affects cerebrovascular resistance and plasma concentrations of adrenomedullin (AM), a vasoactive peptide regulating cerebral blood flow.

Methods: We evaluated 50 infants (age <1 year) with congenital heart defects, matched according to a 2-year follow-up; 40 infants had no overt neurological injury, and 10 had brain damage. Blood samples were taken before surgery, during surgery before CPB, at the end of CPB, at the end of surgery, and at 12 h after surgery. Neurological outcome was evaluated before surgery, on postoperative day 7, and 2 years after surgery. We measured AM concentrations and used Doppler velocimetry to measure middle cerebral artery (MCA) pulsatility index (PI).

Results: The highest MCA PI values and lowest AM concentrations occurred at the end of CPB and of the surgical procedure. Infants who developed abnormal neurologic sequelae had significantly (P <0.001 for both) higher MCA PI values and lower AM concentrations than patients with normal neurologic outcome at the end of CPB and after surgery. As single markers for predicting neurological abnormalities, AM (cutoff: 17.4 ng/L) achieved a sensitivity of 100% and a specificity of 73.0% and MCA PI (cutoff value: 1.8) a sensitivity of 100% and a specificity of 56.8%.

Conclusions: AM concentrations and MCA PI patterns change during CPB, mainly in infants with brain damage, and may be useful for early identification of infants at risk for brain damage.