Awni Al-Subu, MD
Associate Professor of Pediatrics
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Disclosure information not submitted.
Kari Nelson, APNP
Nurse Practitioner
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Kate Amond, NP
Nurse Practitioner
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Paige Selenski
PICU RESEARCH COORDINATOR
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Michael Lasarev, M.S.
Biostatistician
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Entela Lushaj, MD, PhD
Senior Scientist
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Petros Anagnostopoulos, MD, MBA
Professor of Surgery
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Title: Hypovitaminosis and Vitamin C Deficiency in Pediatric Patients Undergoing Cardiopulmonary Bypass
Background: Vitamin C levels are known to be decreased in adult critical illness and associated with illness severity. Cardiopulmonary bypass (CPB) can lead to significant inflammation, endothelial dysfunction, and interruption of nutrition during the perioperative period. Combining these effects, children with congenital heart disease (CHD) and undergoing cardiac surgery might be at increased risk for low circulating vitamin C levels. This study aimed to investigate the risk of hypovitaminosis C (serum concentration < 23 µmol/L) and vitamin C deficiency (serum concentration < 11.4 µmol/L) in pediatric patients with congenital heart disease undergoing surgical repair using cardiopulmonary bypass.
Design/Methods: An ongoing prospective single-center observational study evaluating the perioperative time course of vitamin C levels in critically ill children (< 18 years of age) who are undergoing congenital heart surgery using CPB. Vitamin C serum levels were collected and recorded preoperatively (before CPB) and postoperatively (upon admission to the ICU, 24 hours, and 72 hours).
Results: Thirty-six patients with median age of 8.1 [IQR 2.5,68] months were consented and enrolled between October 2020 and July 2021. Median CPB duration was 117 [86,15] minutes, and hospital length of stay was 8 [4,13] days. Average vitamin C level decreased from 84.1 (sd=24.3) µmol/L before CPB to 55.8 (sd=22.4) µmol/L upon admission to the ICU, a reduction of 28.7 (95% CI: 19.9–37.5; p< 0.001) µmol/L. Levels remained low on post-op days one and three compared to before CPB, averaging 25.3 (95% CI: 16.3–34.3; p< 0.001) and 21.8 (95% CI: 12.8–30.8; p< 0.001) µmol/L lower than before CPB. Three patients had hypovitaminosis C or vitamin C deficiency. Reduction in vitamin C serum levels was not associated with hospital length of stay (p=0.53).
Conclusions: Pediatric patients undergoing cardiac surgery with CPB showed decreased vitamin C levels during the postoperative period. The effects of hypovitaminosis C and vitamin C deficiency in this population remains unclear, and further investigation is needed to understand the potential effect of treatment with intravenous vitamin C.