Submitted to: Journal of Pediatric Surgery
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/20/2000
Publication Date: 9/20/2000
Citation: SHEW, S.B., KESHEN, T.H., GLASS, N.L., JAHOOR, F., JAKSIC, T. LIGATION OF A PATENT DUCTUS ARTERIOSUS UNDER FENTANYL ANESTHESIA IMPROVES PROTEIN METABOLISM IN PREMATURE NEONATES. JOURNAL OF PEDIATRIC SURGERY. 2000. v. 35(9). p. 1277-1281. Interpretive Summary: Premature babies are very small and have only a small amount of proteins in their bodies. When these babies undergo surgery the stress of the procedure causes them to break down and lose body proteins which are very important for their recovery and survival. By giving a painkilling drug called fentanyl to the babies during surgery, the doctors were able to prevent the loss of body proteins. These results suggest that premature babies will recover faster if they are given fentanyl during surgery.
Technical Abstract: BACKGROUND: Although surgical ligation effectively reverses the cardiopulmonary failure associated with patent ductus arteriosus (PDA), previous findings have suggested that such surgery itself elicits a catabolic response in premature neonates. Therefore, the authors sought to quantitatively assess whether PDA ligation under fentanyl anesthesia aggravated or improved the protein metabolism of premature neonates. METHODS: Seven ventilated, premature neonates (birth weight 815 ± 69 g) underwent PDA ligation with standardized fentanyl anesthesia (15 microg/kg) on day-of-life 8.4 ± 1.2 and were studied immediately pre- and 16 to 24 hours postoperatively while receiving continuous total parenteral nutrition (TPN). Whole-body protein kinetics were calculated using intravenous 1-[13C] leucine, and skeletal muscle protein breakdown was measured from the urinary 3-methylhistidine to creatinine ratio (MH:Cr). RESULTS: Whole-body breakdown (10.9 ± 1.2 v 8.9 ± 0.8 g/kg/d, P<.05), turnover (17.4 ± 1.2 v 15.4 ± 0.8 g/kg/d, P < .05), and MH:Cr (1.95 ± 0.20 v 1.71 ± 0.16 micromol:mg, P<.05) decreased significantly after operation. This resulted in a 60% improvement in protein balance (1.6 ± 0.8 v 2.6 ± 0.6 g/kg/d, P = 0.08) postoperatively. CONCLUSION: Because of decreased whole-body protein breakdown, whole-body protein turnover, skeletal muscle protein breakdown, and increased protein accrual, surgical PDA ligation under fentanyl anesthesia promptly improves the protein metabolism of premature neonates enduring the stress of a PDA.