Tetranectin as a Potential Biomarker Associated with Post-Operative Inotropic Support Following the Norwood Procedure in Neonates: A Pilot Study

Background: Tetranectin (TN) is a protein that plays a role in tissue remodeling. In adults with heart failure, TN has a better prognostic value compared to B-type natriuretic peptide (BNP). We aimed to examine changes in TN in neonates following the Norwood operation and explore its prognostic value. Methods: Retrospective observational pilot cohort study in a tertiary pediatric cardiac intensive care unit. Neonates who underwent the Norwood procedure and had stored plasma samples in our biorepository were screened for inclusion. TN and BNP levels were measured by ELISA at five different time points in relation to cardiopulmonary bypass (CPB) in 26 neonates who met the inclusion criteria. The primary outcomes were time to lactate clearance and duration of inotropic support. Results: Univariate analysis showed that higher TN levels at 0 and 4 h were associated with a longer duration of inotropic support. Logistic regression analyses comparing TN levels at different time points with duration of inotropic support showed that TN level at 4 h post-CPB was a significant predictor (p = 0.04) for a longer duration of inotropic support with an AUC of 0.876. Conclusions: In this pilot cohort, higher observed TN concentrations in the early post-operative period were associated with longer duration of inotropic support. TN was not found to be significantly associated with time to lactate clearance. These exploratory findings require validation in larger prospective studies before TN can be considered for clinical prognostication.