Abstract 10814: Standardized Preoperative Corticosteroid Treatment in Neonates Undergoing Cardiac Surgery- Results From a Randomized Trial
Background: A heightened inflammatory response occurs following cardiac surgery in neonates (≤30 days). The perioperative use of glucocorticoids, such as intravenous methylprednisolone (MP), has been advocated as a method to improve post-operative outcomes such as low cardiac output syndrome (LCOS). However, randomized prospective studies to quantify the effect of MP on LCOS and other perioperative outcomes in neonatal cardiac surgery have not been performed. Accordingly, this study tested the hypothesis that pre-operative MP followed by intraoperative MP (Two Dose MP) would improve perioperative recovery as compared to intraoperative MP alone (Single Dose MP) in neonates requiring cardiac surgery.
Methods: Neonates (n=76) scheduled for cardiac surgery were entered into a blinded, randomized study in which either Two Dose (30mg/kg 8 hours preoperatively and 30 mg/kg operatively; n=39) or Single Dose (30 mg/kg operatively; n=37) MP was used. LCOS (standardized score), interleukin-6 (IL-6), inotropic score, fluid balance, serum creatinine, ICU and hospital stay were measured.
Results: Preoperative plasma levels of the inflammatory cytokine IL-6 were reduced by 2-fold (p<0.05) in the Two Dose MP group, consistent with the anti-inflammatory effects of MP. However, the incidence of LCOS was 46% (17/37) in the Single Dose and 38% (15/39) in the Two Dose MP groups (p=0.51); the relative risk for LCOS was unaffected by the Two Dose MP 0.78 (0.45-1.33; 95% confidence interval). Two Dose MP was associated with a higher serum creatinine immediately postoperatively (0.6±0.2 vs 0.5±0.1 mg/dL, p<0.05), with poorer postoperative diuresis (-96±49 mL, p=0.05). Inotropic requirement, duration of mechanical ventilation, ICU, and hospital stay did not differ between the 2 groups.
Conclusions: These unique findings from a prospective randomized trial demonstrate that combined preoperative and intraoperative use of glucocorticoids in neonatal cardiac surgery does not favorably affect early clinical outcomes, and may exacerbate perioperative renal dysfunction. Thus, the hypothesis that perioperative use of glucocorticoids imparts protective effects in the setting of neonatal cardiac surgery must be re-evaluated.
- © 2010 by American Heart Association, Inc.