[The influence of autologous umbilical cord blood and donor blood on cytokine profile of newborns with transposition of great vessels].

We investigated the serum levels ofproinflammatory and antiinflammatory cytokines (TNF-alpha, IL-1beta, IL-6, IL-8, IL-10) in newborns with transposition of the great arteries to whom during the defect correction the autologous umbilical cord blood and blood components were administered before the surgery and at the 1st, 3rd, 7th day after the surgery. We found that in the group of newborns to whom during the operation the blood components were used, the levels ofpro-inflammatory interleukins were high before surgery and at the Ist, 3rd and 7th day after it, but IL-10 was reduced. During the postoperative period, the newborns of this group had imbalance in the system cytokine, accompanied by clinical complications such as hyperthermia and pulmonary complications. Newborns with transposition of the great arteries who had the surgery using the autologous cord blood, had no significant abnormalities in serum levels cytokine before the surgery. The Ist day after surgery there was an increase in both proinflammatory and antiinflammatory cytokines. Up to 7 days the levels of interleukin gradually decreased. Newborns in this group had no postoperative complications, had an adequate immune response to the operation.

Does cardiac surgery in newborn infants compromise blood cell reactivity to endotoxin?

INTRODUCTION: Neonatal cardiac surgery is associated with a systemic inflammatory reaction that might compromise the reactivity of blood cells against an inflammatory stimulus. Our prospective study was aimed at testing this hypothesis. METHODS: We investigated 17 newborn infants with transposition of the great arteries undergoing arterial switch operation. Ex vivo production of the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha), of the regulator of the acute-phase response IL-6, and of the natural anti-inflammatory cytokine IL-10 were measured by enzyme-linked immunosorbent assay in the cell culture supernatant after whole blood stimulation by the endotoxin lipopolysaccharide before, 5 and 10 days after the operation. Results were analyzed with respect to postoperative morbidity. RESULTS: The ex vivo production of TNF-alpha and IL-6 was significantly decreased (P < 0.001 and P < 0.002, respectively), whereas ex vivo production of IL-10 tended to be lower 5 days after the operation in comparison with preoperative values (P < 0.1). Ex vivo production of all cytokines reached preoperative values 10 days after cardiac surgery. Preoperative ex vivo production of IL-6 was inversely correlated with the postoperative oxygenation index 4 hours and 24 hours after the operation (P < 0.02). In contrast, postoperative ex vivo production of cytokines did not correlate with postoperative morbidity. CONCLUSION: Our results show that cardiac surgery in newborn infants is associated with a transient but significant decrease in the ex vivo production of the pro-inflammatory cytokines TNF-alpha and IL-6 together with a less pronounced decrease in IL-10 production. This might indicate a transient postoperative anti-inflammatory shift of the cytokine balance in this age group. Our results suggest that higher preoperative ex vivo production of IL-6 is associated with a higher risk for postoperative pulmonary dysfunction.

Report of a new patient with transposition of the great arteries with deletion of 22q11.2.

We report on a new patient with d-transposition of the great arteries who was found to have deletion of 22q11.2. He had minor facial anomalies, normal T- and B-cell subsets, and transient hypocalcemia. Similar to rare previous reports, our patient's extracardiac manifestations were relatively mild.