부산대학교 도서관

Introduction: Cyclohexanone, an industrial medical plastic fabrication contaminant, can leach from medical plastics including the cardiopulmonary bypass (CPB) circuit. Effects of neonatal perioperative cyclohexanone exposure on hospital-based outcomes have not been explored.Hypothesis: We hypothesize that serum cyclohexanone during congenital heart surgery with CPB is associated with worse morbidity.Methods: The study was a secondary analysis of 107 neonates enrolled in the NHLBI-funded Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass trial. Blood samples were collected preoperatively, post-CPB, and 12 hours postoperatively, and concentrations of cyclohexanone and its metabolites were quantified using mass spectrometry. Using the geometric mean of cyclohexanone concentrations, the effects of an interquartile range (IQR) increase in concentration on hospital-based outcomes was assessed using adjusted linear and Poisson regression, for continuous and dichotomous outcomes, respectively. Estimates were reported as % differences (linear regression) or relative risks (Poisson regression) with 95% confidence intervals.Results: In adjusted analyses, an IQR increase in mean cyclohexanone concentration was associated with greater time spent on mechanical ventilation (40.1%: 7.34%, 82.9%), in the ICU (20.1%: 1.36%, 42.2%), and in the hospital (20.8%: 3.28%, 41.3%), and less time spent alive and out of the hospital 90 days post-surgery (-17%: -30.9%, -0.36%). An IQR increase in mean cyclohexanone was associated with a 61% (RR: 1.61; 1.19, 2.17) greater risk of the trial primary morbidity-mortality composite outcome (death, cardiac arrest, ECMO, renal or hepatic insufficiencies, and lactic acidosis). An IQR increase in mean cyclohexanone metabolites was associated with a 29% (RR: 1.29; 1.07, 1.55) greater risk of developing low cardiac output syndrome.Conclusions: This study showed that in neonates, circulating cyclohexanone was associated with unfavorable hospital-based outcomes following cardiac surgery with CPB, suggesting that medical plastic contamination may contribute to morbidity. Therefore, reducing exposure to cyclohexanone perioperatively may improve congenital heart surgery outcomes.