The loss of gut wall integrity through non-abdominal surgical trauma in adults, children and neonates

Children undergoing major surgery often develop systemic inflammatory response
syndrome (SIRS) and sepsis. Patients with SIRS and sepsis have an increased
risk of developing multiple organ failure (MOF), which is the leading cause of
death in surgical patients.
We hypothesize that surgical stress, such as blood loss causing splanchnic
hypoperfusion, in combination with the inflammation caused by significant
tissue trauma, leads to intestinal epithelial damage. Subsequently, the loss of
normal intestinal barrier function leads to translocation of bacteria causing
SIRS and possibly sepsis.
Because newborns, children and adults have a different bacterial colonization
of the intestinal tract and the immune system matures only during childhood, we
hypothesize to find different intestinal and inflammatory responses during and
after surgery in these age groups. Therfore, the study evaluates whether there
is any difference in gut damage and inflammatory response between adult,
pediatric and neonatal surgical populations.

To examine the effect of surgical trauma on mucosal perfusion, intestinal
epithelial damage, the inflammatory response and potentially sepsis, following
surgery remote to the abdomen in adults, children and neonates,

The study will be a longitudinal, observational study of adults, children and
neonates undergoing major non-abdominal surgery. In adults and children we will
study patients that undergo scoliosis repair surgery. In neonates we will study
patients undergoing thoracotomy. All patients will subsequently be admitted to
ICU, PICU or NICU respectively. In neonates we will sample urine. In adults and
children we will only sample blood. We will obtain an initial blood or urinary
sample upon induction of anesthesia before surgery commences. Subsequent plasma
respectively urine sampling will occur every two hours after the start of
surgery, 2 hours after wound closure, and then daily for at least 48 hours. A
gastric tonometry catheter will be introduced for measurement of intramucosal
CO2 pressure in children and adults.

To study intestinal cell damage we will use I-FABP, ILBP and L-FABP. To study
inflammation we will use neutrophil activation product, complement activation
and the cytokine response. To study splanchnic hypoperfusion we will perform
gastric tonometry.

A total of 18 ml and 36 ml of blood will be sampled from respectively children
and adults over a time period of 48 hours.
Blood will be sampled from either an arterial or central venous line intra- and
immediately post-operatively, and then concurrent with the normal daily blood
testing post-operatively.
In neonates we will collect 1 ml urine every 2 hours during surgery and 2, 12,
24 and 48 hours postoperatively. Urine will be sampled from a CAD, which will
be placed at any case before start of surgery.
A gastric tonometry catheter will be introduced after aneasthesia for
measurement of intramucosal CO2 pressure during surgery in children and adults.
Blood/ urine sampling and gastric tonometry do not bring an extra risk for the
patient.

Patients do not directly benefit but all patients that will undergo major
surgery in the future will.