Endotoxin Activity in Neonates Undergoing Cardiac Surgery: Cohort Study

Abstract

Endotoxin activity assay levels increase after elective neonatal surgery and are not modified by refeeding. High postoperative levels may predict feeding intolerance.

Alkaline Phosphatase Activity and Endotoxemia After Infant Cardiothoracic Surgery

“…The whole blood sample was used to measure EAA (Spectral Medical, Inc., Toronto, Ontario, Canada) as previously described. 10,12,13 EAA is an FDA cleared, clinically available test to assess the level of endotoxemia and aid in the risk assessment of critically ill patients. While the test was primarily designed and approved for use in sepsis as above, it has been previously utilized to assess endotoxemia following cardiopulmonary bypass.…”

“…While the test was primarily designed and approved for use in sepsis as above, it has been previously utilized to assess endotoxemia following cardiopulmonary bypass. 10,12,13 Briefly, EAA measures the biologic response of the subject's neutrophils to a complex of circulating endotoxin and exogenously added anti-endotoxin IgM. The subsequent chemoluminescent burst is measured on a luminometer and compared to separate controls with either basal or maximal burst.…”

“…Pediatric cardiac surgery with cardiopulmonary bypass (CPB) reproducibly results in endotoxemia secondary to increased intestinal permeability. [10][11][12][13][14] Inflammation triggered by endotoxemia may contribute to post-operative instability as evidenced by the association of endotoxemia with increased post-operative inotrope requirements and increased pediatric cardiac intensive care unit (CICU) length of stay. 10,13 AP activity also changes consistently after infant cardiac surgery with CPB.…”

Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

“…TNAP is the dominant circulating isoenzyme and has been successfully used as a biomarker of liver and bone disease [17]; however, its physiological role is not fully understood. Recently, APs have been shown to dephosphorylate and detoxify two key pathologic molecules thought to contribute to inflammation and organ injury after both cardiac surgery and sepsis: bacterial-derived lipopolysaccharide (LPS-endotoxin) [10,[18][19][20][21][22][23][24][25] and extracellular adenine nucleotides (ATP, ADP, and AMP) released during cellular necrosis or apoptosis [26][27][28][29][30]. AP removes one phosphate group from the conserved lipid A moiety of LPS resulting in a monophosphoryl product with reduced toxicity [21,31].…”

Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest

“…[15,16] TNAP is the dominant circulating isoenzyme and has been successfully used as a biomarker of liver and bone disease; [17] however, its physiological role is not fully understood. Recently, APs have been shown to dephosphorylate and detoxify two key pathologic molecules thought to contribute to in ammation and organ injury after both cardiac surgery and sepsis: bacterial-derived lipopolysaccharide (LPS-endotoxin) [10,[18][19][20][21][22][23][24][25] and extracellular adenine nucleotides (ATP, ADP, and AMP) released during cellular necrosis or apoptosis. [26][27][28][29][30] AP removes one phosphate group from the conserved lipid A moiety of LPS resulting in a monophosphoryl product with reduced toxicity.…”