The effect of preoperative and postoperative serum ischemia modified albumin levels on mortality and early morbidity in patients operated in the neonatal period due to congenital heart disease

Objective: Congenital heart diseases are very common in the neonatal period and are caused by the developing problems of the heart in the antenatal period. Different markers and classifications are being sought to determine its prognosis. For this purpose, we aimed to investigate the usability of ischemic modified albumin (IMA), which can determine the prognosis of congenital heart patients who underwent inpatient surgery in the Neonatal Intensive Care Unit of Çukurova University Medical Faculty Hospital and which is considered an important marker in adult myocardial infarction. Materials and Methods: 57 newborns with congenital heart disease that were followed up at ÇÜTF NICU between May 2018 and December 2019 and had heart surgery were included in the study. During the same period, 38 newborns that were not diagnosed with congenital heart disease and were not exposed to hypoxia were included as the control group. Ischemic modified albumin levels in the patient group were measured in the last 24 hours preoperatively and at the 8th hour postoperatively using the Shimadzu 1800 spectrophometer device using the Absorbance Unit (ABSU) method. Vital parameters, demographic characteristics, lactate levels and hypotension, arrhythmia coagulopathy, inotropic needs and supportive treatments that may indicate hypoxia-ischemia of the study group were recorded. In the control group, ischemic modified albumin level was measured from the serum sample taken for bilirubin control and demographic characteristics were recorded. Preoperative and postoperative ischemic modified albumin values of the study group according to the ischemic modified albumin value of the control group were compared with the IMA values of the control group in terms of prognoses and treatments. Results: IMA values of preoperative and postoperative of study group patients and the of the control group were 0,22±0,07 ABSU, 0,23±0,07 ABSU and 0,19±0,09 ABSU respectively. The preoperative IMA values of the study group and the control group were, were not different statistically (p=0,192). There was a statistically significant difference between the postoperative IMA values of the study group and the IMA values of the control group (p=0,028). When we compared the IMA values of the control group, there was no statistical difference between the pre-postoperative IMA values below and above this value and the parameters such as discharge, bleeding, coagulopathy, lactate level, postoperative length of stay, etc. Pre-postoperative IMA values between patients who died due to congenital heart disease or surgery and those who were discharged were not statistically significant (p=0,57). There was no statistical difference between pre and postoperative IMA values according to lactate, coagulaopathy, history of intraoperative arrest, creatinine elevation, which were determined as prognostic factors. Conclusions: Congenital heart disease may itself be a cause of primary hypoxia and myocardial dysfunction. Surgery and subsequent care may be associated with conditions such as hypoxia and myocardial dysfunction and sepsis. While ischemic modified albumin is used as a parameter in adults to determine these, it was not found significant in congenital heart disease in the neonatal age group both before and after the operation. In the neonatal age group, the myocardium being well protected in the pre, intra and postoperative periods and the low number of patients may have caused this. The role of ischemic modified albumin value in the prognosis of congenital heart disease can be investigated in multi-center studies involving more patients.