title: Comparison of Profiles of Perioperative Serum C-Reactive Protein Levels in Neonates Undergoing the Norwood Procedure or Arterial Switch Operation.
abstract: OBJECTIVE
  Serum C-reactive protein (CRP) is a marker of systemic inflammatory response induced by cardiopulmonary bypass (CPB). Neonates undergoing the Norwood procedure (NP) have a poorer systemic oxygen transport status than those after other CPB surgeries. We compared the perioperative CRP in neonates undergoing NP or arterial switch operation (ASO).
  
  
  METHODS
  Data obtained prior to and within postoperative day (POD) 15 from 64 neonates in NP group and 47 in ASO group. Plasma CRP, white blood cells, doses of inotropes and steroid, cultures of blood and body fluids were recorded simultaneously. Demographic data included the durations of CPB, aortic cross clamp (ACC) and circulatory arrest, intensive care unit and hospital stay, and death.
  
  
  RESULTS
  NP group had a shorter CPB and ACC but a longer circulatory arrest than ASO group. CRP was higher preoperatively in NP group than ASO group (21 ± 24 vs.13 ± 26 mg/L, P = 0.01). CRP increased to 80 ± 48 mg/L after NP and 73 ± 36 mg/L after ASO on POD1-2, and then gradually decreased to 51 ± 35 mg/L in NP group and to 43 ± 46 mg/L in ASO group by POD-15. Throughout the postoperative period, CRP, as well as lactate, was significantly higher in NP group than ASO group (P = 0.04 and 0.003, respectively). CRP correlated positively with neutrophil count and negatively with lymphocyte count, CPB duration, and doses of hydrocortisone.
  
  
  CONCLUSIONS
  Neonates undergoing NP have a higher level of serum CRP, reflecting a greater systemic inflammatory response before and after CPB than those undergoing ASO, despite of shorter CPB and ACC. The higher level of serum CRP was associated with a significantly higher level of arterial lactate in the NP group than in the ASO group. This may suggest an important role of systemic oxygen transport in systemic inflammatory response in addition to CPB in neonates with congenital heart defects.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Santokh
authors.initials: S
authors.lastname: Dhillon
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Xiaoyang
authors.initials: X
authors.lastname: Yu
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Andriy
authors.initials: A
authors.lastname: Cheypesh
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.|Clinical Physiology Research Center, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Li
mesh_terms: D000069278:Arterial Switch Operation; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D006330:Heart Defects, Congenital / Q000097:blood* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D058327:Norwood Procedures; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Arterial Switch Operation; C-Reactive Protein; Systemic Inflammatory Response; The Norwood Procedure