Metabolomic profiling of infants undergoing cardiopulmonary bypass and association with clinical outcomes: a systematic review

Leonardo Meggiolaro; Laura Moschino; Matteo Stocchero; Giuseppe Giordano; Vladimiro Vida; Giovanni Di Salvo; Eugenio Baraldi

doi:10.3389/fcvm.2024.1491046

Metabolomic profiling of infants undergoing cardiopulmonary bypass and association with clinical outcomes: a systematic review

Front Cardiovasc Med. 2024 Nov 14:11:1491046. doi: 10.3389/fcvm.2024.1491046. eCollection 2024.

Authors

Leonardo Meggiolaro¹, Laura Moschino^{1

2}, Matteo Stocchero², Giuseppe Giordano², Vladimiro Vida³, Giovanni Di Salvo⁴, Eugenio Baraldi^{1

2}

Affiliations

¹ Neonatal Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy.
² Fondazione Istituto di Ricerca Pediatrica Città Della Speranza, Padova, Italy.
³ Paediatric Cardiac Surgery, Padova University Hospital, Padova, Italy.
⁴ Paediatric Cardiology Unit, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy.

Abstract

Introduction: The incidence of adverse short-term outcomes for infants who undergo complex congenital heart disease (CHD) surgery with cardiopulmonary bypass (CPB) is still high. Early identification and treatment of high-risk patients remain challenging, especially because clinical risk factors often fail to explain the different outcomes of this vulnerable population. Metabolomics offers insight into the phenotype of the patient and the complex interplay between the genetic substrate and the environmental influences at the time of sampling. For these reasons, it may be helpful to identify the mechanisms of physio-pathological disruptions experienced in neonates undergoing congenital heart surgery and to identify potential therapeutic targets.

Methods: We conducted a systematic review (PROSPERO: ID 565112) of studies investigating the association between targeted or untargeted metabolomic analysis of infants undergoing elective surgery with CPB for CHD and clinical outcomes. The PRISMA guidelines were followed. We searched MEDLINE via PubMed, EMBASE via Ovid, the Cochrane Central Register of Controlled Trials, the Cochrane Library, ClinicalTrials.gov and the World Health Organization's International Trials Registry and Platform.

Results: Seven studies involving 509 children (aged 1 day to 21.3 months), all of whom underwent cardiac surgery requiring CPB, were included for qualitative analysis. We found associations between metabolomic profiles and various clinical outcomes, such as mortality, acute kidney injury (AKI), and neurological outcomes. Specific metabolites (mainly amino acids, their metabolic products and fatty acids) were identified as potential biomarkers for these outcomes, demonstrating the utility of metabolomics in predicting certain postoperative complications.

Conclusion: The quality of the evidence was limited due to heterogeneity in study designs and small sample sizes, but the findings are promising and suggest that further research is warranted to confirm these associations.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, PROSPERO ID 565112.

Keywords: bypass; cardiopulmonary; clinical outcomes; congenital; heart defects; infants; metabolomics; newborn.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the Pediatric Residency Program of the Department of Women and Child Health at the University of Padova, 2021. Additional funding supports: the Institute for Pediatric Research (IRP, Padova, Italy) to AG, 2019; the Italian Ministry of Health Call for Proposals GR-RF 2019-12368539. Open Access funding provided by Università degli Studi di Padova | University of Padua, Open Science Committee.