Article Text

MAJOR SURGERY DIFFERENTLY ACTIVATES SYSTEMIC STRESS, INFLAMMATORY AND IMMUNE RESPONSE IN NEONATES AND INFANTS
  1. S Grosek1,
  2. M Gams2,
  3. A Gortnar3,
  4. A N Kopitar4,
  5. T Gmeiner-Stopar5,
  6. M Susec-Michieli6,
  7. J Primozic1,
  8. J Erzen7,
  9. A Ihan4
  1. 1Department of Pediatric Surgery and Intensive Care, University Medical Center Ljubljana, Ljubljana, Slovenia
  2. 2General Hospital Dr Franc Derganc, Sempeter Pri Novi Gorici, Slovenia
  3. 3Department for Internal Diseases, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
  4. 4Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  5. 5Department for Nuclear Medicine, Radiopharmacy and Clinical Biochemistry, University Medical Center Ljubljana, Ljubljana, Slovenia
  6. 6Former Member of Institute of Biomedical Informatics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  7. 7Department of Thoracic Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia

Abstract

Objectives To determine the influence of major surgery on systemic stress, inflammatory and immune response in neonates and infants.

Methods A prospective study on systemic stress, inflammatory and immune response was undertaken. Blood samples were collected at five different times: just before and immediately after the surgery, and 24, 48 and 72 h after the procedure. We measured the serum cortisol level, the lymphocyte and lymphocyte subset counts, index of activated monocytes (iHLA-DR+), C-reactive protein (CRP), procalcitonin and activated granulocyte (CD64) concentrations.

Setting Paediatric Surgical Department, University Medical Centre Ljubljana, Slovenia.

Results Seven neonates and eight infants were included. The levels of cortisol fell significantly in neonates, whereas they increased in the infants after the operation. There was a greater increase in CRP and procalcitonin values in the infants compared with the neonates, whereas the opposite was the case for CD64. The entire observed postoperative period resulted in a fall in T-lymphocyte concentrations in the group of neonates (from 2884 to 1607 cells/μl; p = 0.014) and infants (from 2270 to 1335 cells/μl; p = 0.034) and in their subsets CD4 and CD8. The iHLA-DR+ was lowered in both groups: from 1 to 0.82 for neonates and significantly to 0.66 (p = 0.005) for infants. The severity of the decrease in the CD8 T-lymphocyte subset counts and iHLA-DR+ characteristically differed between the two groups.

Conclusions Major surgery caused a different systemic stress, inflammatory and immune response in the group of neonates compared with the group of infants.

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