povidone-iodine and Heart-Defects--Congenital

Thyroid hormone alterations after cardiac surgery may be aggravated by the use of iodine antiseptics. We evaluated thyroid function and ioduria in infants with delayed sternal closure (DSC) who are exposed to povidone-iodine for sternal wound protection and compared them with findings in infants after primary sternal closure.. Prospective clinical study.. Pediatric cardiac intensive care unit.. Ninety-three infants after cardiac surgery using cardiopulmonary bypass, 60 of them with primary sternal closure and 33 of them with delayed sternal closure.. Thyroid hormones were studied in patients with primary sternal closure immediately after surgery, 5 days and 19 days after surgery, in patients with DSC immediately after surgery, immediately after sternal closure, and 2 wks after sternal closure. Ioduria was evaluated on the first, third, and fifth postoperative days after cardiac surgery with primary sternal closure and immediately after DSC. In both groups of patients, low total triiodothyronine, total thyroxine, thyroxine-binding globulin levels, high reverse triiodothyronine levels, and normal free triiodothyronine, free thyroxine, and thyroid-stimulating hormone levels were recorded immediately after surgery. Concentrations of total triiodothyronine and thyroid-stimulating hormone were lower in the patients with DSC. Five days after primary sternal closure and 2 wks after DSC, all thyroid hormone levels were normal for age. Ioduria after DSC was higher than ioduria after primary sternal closure.. Patients with DSC compared with patients with primary sternal closure display more profound thyroid suppression in the immediate postoperative period. The use of povidone-iodine adhesive drapes with single povidone-iodine mediastinal irrigation in patients with DSC is associated with significant iodine absorption but no significant thyroid dysfunction.

Topics: Anti-Infective Agents, Local; Cardiopulmonary Bypass; Follow-Up Studies; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Iodine; Povidone-Iodine; Prospective Studies; Thoracotomy; Thyroid Function Tests; Thyroid Hormones; Time Factors

Cardiopulmonary bypass has profound effects on thyroid hormone metabolism. These effects may be exacerbated in infants because they are able to absorb large quantities of iodine transcutaneously. The purpose of this study was to test the hypothesis that preoperative povidone-iodine contributes to postoperative thyroid depression in infants who undergo cardiac surgery.. Prospective, randomized, controlled trial.. Children's Hospital and Medical Center, Seattle, WA.. Thirty-seven infants undergoing repair of congenital cardiac defects.. Infants requiring cardiopulmonary bypass were divided into two groups: Group 1 received povidone-iodine; group 2 received chlorhexidine as a topical preoperative antiseptic. Group 3 did not require cardiopulmonary bypass for repair of cardiac defects and received povidone-iodine as a preoperative antiseptic.. Thyrotropin (TSH), total triiodothyronine (T3), and thyroxine (T4) were measured at four intervals: a) before preparation for surgery; b) immediately after surgery; c) at 2 days after surgery; and d) at 5 to 8 days after surgery. There was a significant decrease in TSH concentrations immediately after surgery in the two bypass groups. This change was significantly greater than in the change in TSH concentration in the thoracotomy group. Total T3 and T4 concentrations decreased by postoperative day 2 in both groups 1 and 2, and the changes were significant compared with group 3. Total T3 and T4 concentrations increased significantly in all groups after postoperative day 2, with no significant difference between the three groups.. Cardiopulmonary bypass has a more significant effect on thyroid hormone metabolism than does the preoperative antiseptic.

Topics: Anti-Infective Agents, Local; Cardiopulmonary Bypass; Chlorhexidine; Female; Heart Defects, Congenital; Humans; Hypothyroidism; Infant; Male; Povidone-Iodine; Prospective Studies; Thyrotropin; Thyroxine; Time Factors; Triiodothyronine

To evaluate the influence of the intravenous injection of iodine during cardiac catheterisation, and of topical iodine antiseptics during surgical procedures, on thyroid function in full term neonates.. Twenty one full term infants with major cardiac anomalies who survived for more than a month were studied. Thyroxine and thyrotropin concentrations were measured (by radioimmunoassay) before each procedure, 24 hours after the procedure, and every week thereafter until the age of 1 month or until normal. Thyroxine values less than 64.4 nmol/l were considered low, while thyrotropin values greater than 30 mU/l were considered high.. Thyroid function tests before iodine exposure were within normal limits in all infants. Following catheterisation or surgery six infants had raised thyrotropin concentrations; three had low thyroxine concentrations. Two of those infants were treated with L-thyroxine.. Iodine exposure during cardiac catheterisation or surgery may induce transient hypothyroidism in term infants.

Topics: Anti-Infective Agents, Local; Cardiac Catheterization; Contrast Media; Heart Defects, Congenital; Humans; Hypothyroidism; Infant, Newborn; Iodine; Povidone-Iodine; Prospective Studies; Thyrotropin; Thyroxine; Triiodobenzoic Acids

Povidone-iodine is an effective antiseptic, but its topical use has been associated with a number of adverse reactions in burn patients and in neonates as a result of transcutaneous absorption. In particular, high plasma iodine concentrations are known to cause renal failure, metabolic acidosis, and thyroid suppression. Because of the permeable nature of the skin in small infants and the large areas cleaned before cardiac operations, it is possible that significant transcutaneous iodine absorption might occur in this situation. We have studied 17 infants, less than 3 months of age, who were undergoing closed cardiac or thoracic procedures. After povidone-iodine skin preparation in 15 (covering 20% to 30% of body surface area), plasma total iodine concentrations rose fourfold (range, 160% to 1,440%). This increase was significantly different from the preoperative level at 6, 12, 18, and 24 hours. There was no increase in plasma iodine concentration in 2 patients who were not exposed to povidone-iodine or any other iodine-containing compound. We discuss the implications for a topical antisepsis policy in infants.

Topics: Body Surface Area; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Iodine; Male; Povidone-Iodine; Preoperative Care; Risk Factors; Skin Absorption