{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T20:06:07Z","timestamp":1784664367661,"version":"3.55.0"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Private Gran GODIA"},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Cardiac surgery (CS) in pediatric patients induces an overt oxidative stress (OS) response. Children are particularly vulnerable to OS related injury. The immaturity of their organs and antioxidant systems as well as the induction of OS in cardio-pulmonary bypass (CPB) surgery may have an important impact on outcomes. The purpose of this study was to describe the OS response, measured by urinary free 8-iso-PGF2\u03b1, in infants undergoing CS and to evaluate the relationship between OS response and post-operative clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Infants with congenital heart disease undergoing CS with or without CPB were eligible for enrollment. Children were classified as neonates (&lt;30 days) or infants (30 days\u20146 months) based on the age at surgery. Perioperative continuous non-invasive neuromonitoring included amplitude-integrated electroencephalogram and cerebral regional oxygen saturation measured with near-infrared spectroscopy. Urine 8-iso-PGF2\u03b1 levels were measured before, immediately post-, and 24-hours post-surgery, and the 8-iso-PGF2 clearance was calculated.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Sixty-two patients (60% neonates) were included. Urine 8-iso-PGF2\u03b1 levels 24 hours after surgery (8.04 [6.4\u201310.3] ng\/mg Cr) were higher than pre-operative levels (5.7 [4.65\u20137.58] ng\/mg Cr) (p&lt;0.001). Those patients with a severe degree of cyanosis caused by Transposition of the Great Arteries (TGA) had the highest post-operative 8-iso-PGF2\u03b1 levels. Patients with intra-operative seizures had higher post-operative 8-iso-PGF2\u03b1 levels. 8-iso-PGF2\u03b1 clearance at 24 hours post-surgery was different between newborns and infant patients, and it was inversely correlated with days of mechanical ventilation (p = 0.05), ICU LOS (p = 0.05) and VIS score at 24 hours (p = 0.036).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Children undergoing CS, particularly neonatal patients, experience a significant post-operative OS response that might play an important role in postoperative morbidity. TGA patients undergoing arterial switch operations demonstrate the highest post-operative OS response. Rapid clearance of isoprostanes, which occurs more frequently in older patients with more mature antioxidant systems, might be associated with better clinical outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250124","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T17:32:13Z","timestamp":1625592733000},"page":"e0250124","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes"],"prefix":"10.1371","volume":"16","author":[{"given":"Stephanie","family":"Hadley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Ca\u00f1izo Vazquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Lopez Abad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Congiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmytro","family":"Lushchencov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9202-4664","authenticated-orcid":true,"given":"Marta","family":"Camprub\u00ed Camprub\u00ed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9108-4750","authenticated-orcid":true,"given":"Joan","family":"Sanchez-de-Toledo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"key":"pone.0250124.ref001","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/1971452","article-title":"Oxidative stress after surgery on the immature heart","volume":"2016","author":"D Fudulu","year":"2016","journal-title":"Oxid Med Cell Longev"},{"key":"pone.0250124.ref002","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1034\/j.1399-6576.2001.045006671.x","article-title":"The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children","volume":"45","author":"V Brix\u2010Christensen","year":"2001","journal-title":"Acta Anaesthesiol Scand"},{"key":"pone.0250124.ref003","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/S0003-4975(99)01420-4","article-title":"Off-pump bypass graft operation significantly reduces oxidative stress and inflammation","volume":"69","author":"BM Matata","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"pone.0250124.ref004","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S0022-5223(05)80022-4","article-title":"Plasma antioxidant depletion after cardiopulmonary bypass in operations for congenital heart disease","volume":"110","author":"LA Pyles","year":"1995","journal-title":"J Thorac Cardiovasc Surg"},{"key":"pone.0250124.ref005","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.redox.2017.03.011","article-title":"Oxygen and oxidative stress in the perinatal period","volume":"12","author":"I Torres-Cuevas","year":"2017","journal-title":"Redox Biol"},{"key":"pone.0250124.ref006","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.jtcvs.2008.12.028","article-title":"The effects of normoxic versus hyperoxic cardiopulmonary bypass on oxidative stress and inflammatory response in cyanotic pediatric patients undergoing open cardiac surgery: a randomized controlled trial","volume":"38","author":"M Caputo","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"key":"pone.0250124.ref007","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1111\/pan.12040","article-title":"Oxidative stress markers are not associated with outcomes after pediatric heart surgery","volume":"23","author":"PH Manso","year":"2013","journal-title":"Paediatr Anaesth"},{"key":"pone.0250124.ref008","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1080\/13547500500216546","article-title":"F2-isoprostanes as markers of oxidative stress in vivo: an overview","volume":"10","author":"GL Milne","year":"2005","journal-title":"Biomarkers"},{"issue":"6","key":"pone.0250124.ref009","first-page":"454","volume":"85","author":"M Rohit","year":"2018","journal-title":"Acyanotic and Cyanotic Congenital Heart Diseases. 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