title: Time course of C-reactive protein and inflammatory mediators after neonatal surgery.
abstract: OBJECTIVE
  To characterize the perioperative course of C-reactive protein (CRP) and inflammatory mediators in neonates ≤44 weeks' corrected gestational age.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, Northwest Permanente, Providence St Vincent Medical Center, Portland, OR, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Nguyen-Vermillion
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Juul
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: McPherson
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ledbetter
mesh_terms: D000005:Abdomen / Q000601:surgery; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis*; D000013:Congenital Abnormalities / Q000601:surgery; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007378:Interleukins / Q000097:blood*; D011184:Postoperative Period; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures; D014138:Tracheoesophageal Fistula / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; D000667:Ampicillin; D002097:C-Reactive Protein