S-100 after correction of congenital heart defects in neonates: Is it a reliable marker for cerebral damage?

Background. Newborns undergoing cardiac operation may acquire some extent o f neuronal damage. An early diagnosis is especially hard regarding neonates . In the past years, S-100 has been widely discussed as a marker revealing perioperative damage to the brain. Methods. Sequential blood samples from 33 neonates undergoing repair of con genital heart disease were taken perioperatively. Samples of 12 healthy neo nates were taken at birth as a control group. The newborns were divided int o four groups: cyanotic and acyanotic disease operated on in deep hypotherm ic circulatory arrest, operation without deep hypothermic cardiac arrest, a nd operation without extracorporeal circulation. Results. Even in healthy neonates, serum S-100 levels were at 10-fold value s compared with adults. On admission, S-100 values in the operative groups were similar. During extracorporeal circulation, levels rose to a certain d egree. Cyanotic newborns operated on in deep hypothermic cardiac arrest had significantly higher S-100 levels compared with acyanotic newborns also op erated on in deep hypothermic cardiac arrest (p < 0.001). Two newborns who experienced seizures postoperatively had the highest absolute S-100 levels. One child with a poor neurologic outcome hut no seizures did not have diff erent values when compared with her group. Conclusions. In this study, S-100 seemed to be a possible marker for a cert ain degree of neurologic deficit after cardiac operation in neonates, espec ially regarding postoperative seizures. The missing peaks of this protein i n one newborn with poor neurologic outcome show that it is not possible to exclude damage to the brain with normal postoperative values. These results suggest that the mechanism of cerebral damage and S-100 release into the b lood in neonates with a developing central nervous system and blood-brain b arrier is not fully understood. (C) 2000 by The Society of Thoracic Surgeon s.